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Kundu S, Jha SB, Rivera AP, Flores Monar GV, Islam H, Puttagunta SM, Islam R, Sange I. Multiple Myeloma and Renal Failure: Mechanisms, Diagnosis, and Management. Cureus 2022; 14:e22585. [PMID: 35371791 PMCID: PMC8958144 DOI: 10.7759/cureus.22585] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/05/2022] Open
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Manohar S, Nasr SH, Leung N. Light Chain Cast Nephropathy: Practical Considerations in the Management of Myeloma Kidney-What We Know and What the Future May Hold. Curr Hematol Malig Rep 2018; 13:220-226. [PMID: 29725932 DOI: 10.1007/s11899-018-0451-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To update and evaluate the current knowledge on pathogenesis and management of light chain cast nephropathy. Light chain cast nephropathy (LCCN) is the leading cause of acute renal failure in patients with multiple myeloma and is currently recognized as a myeloma defining event. RECENT FINDINGS The immunoglobulin free light chain plays an integral role in the pathogenesis of LCCN. The level of free light chain (FLC) in the blood and urine is directly associated with the risk of developing LCCN. Recovery of renal function is related to the speed and degree of the serum FLC reduction. Recently, two randomized trials using high cutoff dialyzer for the removal of serum FLC produced different results in terms of renal recovery. FLC plays a key role in the development and resolution of LCCN. Future therapies will aim to rapidly reduce its concentration or interrupt its interaction with Tamm-Horsfall protein.
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Affiliation(s)
- Sandhya Manohar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology and Pathology Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55901, USA.
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Kishi S, Obata F, Miki H, Matsuura M, Nishimura K, Tamaki M, Kishi F, Murakami T, Abe H, Nagai K, Abe M, Doi T. Lambda Light Chain Non-crystalline Proximal Tubulopathy with IgD Lambda Myeloma. Intern Med 2018; 57:3597-3602. [PMID: 30101939 PMCID: PMC6355399 DOI: 10.2169/internalmedicine.1323-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Light Chain Proximal Tubulopathy (LCPT) is a rare form of paraprotein-related kidney disease in which monoclonal free light chains damage the proximal renal tubular epithelial cells. We herein report the case of a 78-year-old woman who presented with anemia and kidney dysfunction. Serum and urine protein electrophoresis analyses revealed a monoclonal IgD and λ free light chains. Proximal tubular injury and the accumulation of λ light chains were found by kidney biopsy. Electron microscopy revealed no organized structure suggestive of crystals. LCPT was caused by IgD lambda myeloma and bortezomib and dexamethasone therapy led to very good partial response (VGPR) without a worsening of the kidney function.
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Affiliation(s)
- Seiji Kishi
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Fumiaki Obata
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Hirokazu Miki
- Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Japan
| | - Motokazu Matsuura
- Department of Nephrology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Kenji Nishimura
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Masanori Tamaki
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Fumi Kishi
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Taichi Murakami
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Hideharu Abe
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Kojiro Nagai
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Toshio Doi
- Department of Nephrology, Graduate School of Biomedical Sciences, Tokushima University, Japan
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Favà A, Fulladosa X, Montero N, Draibe J, Torras J, Gomà M, Cruzado JM. Treatment of multiple myeloma with renal involvement: the nephrologist's view. Clin Kidney J 2018; 11:777-785. [PMID: 30524711 PMCID: PMC6275441 DOI: 10.1093/ckj/sfy065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/13/2018] [Indexed: 12/23/2022] Open
Abstract
Renal injury is a common complication in multiple myeloma (MM). In fact, as many as 10% of patients with MM develop dialysis-dependent acute kidney injury related to increased free light chain (FLC) production by a plasma cell clone. Myeloma cast nephropathy (MCN) is the most prevalent pathologic diagnosis associated with renal injury, followed by light chain deposition disease and light chain amyloidosis. Several FLC removal techniques have been explored to improve kidney disease in MM but their impact on renal clinical outcomes remains unclear. According to the evidence, high cut-off haemodialysis should be restricted to MM patients on chemotherapy with histological diagnosis of MCN and haemodialysis requirements. From our perspective, more efforts are needed to improve kidney outcomes in patients with MM and renal failure.
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Affiliation(s)
- Alexandre Favà
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Juliana Draibe
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Joan Torras
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Montse Gomà
- Pathology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Idibell, Barcelona, Spain
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Cisplatin-Induced Nephrotoxicity and HIV Associated Nephropathy: Mimickers of Myeloma-Like Cast Nephropathy. Case Rep Nephrol 2017; 2017:6258430. [PMID: 28770116 PMCID: PMC5523540 DOI: 10.1155/2017/6258430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 12/03/2022] Open
Abstract
Myeloma cast nephropathy is an obstructing disorder of renal tubules, caused by precipitation of Bence Jones proteins. Myeloma-like cast nephropathy (MLCN) has been reported in the literature to occur in various primary renal and nonrenal diseases. We present a series of three rare cases of cast nephropathy, two of which are HIV patients, and the third patient is receiving cisplatin-based chemotherapy. However, in all three patients plasma cell dyscrasia has been ruled out. A 30-year-old male was admitted to the hospital with facial cellulitis. The second patient is a 31-year-old male who presented with Pneumocystis jiroveci pneumonia. The third patient was treated with cisplatin-based chemotherapy for carcinoma. First two cases revealed foci of diffuse tubular dilatation containing hyaline casts and interstitial inflammatory infiltrate, in addition to globally sclerotic glomeruli with ultrastructural foot process fusion and mesangium expansion. The third case showed acute tubular injury and cast formation of irregular casts composed of amorphous or granular material of low density admixed with scattered high electron-dense globules. Myeloma-like cast nephropathy and true myeloma cast nephropathy pose similar destructive effects on renal parenchyma. This new pattern of HIV-related nephropathy should be considered in HIV patients with MLCN, once monoclonal gammopathy is ruled out.
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Dmoszyńska A, Walter-Croneck A, Usnarska-Zubkiewicz L, Stella-Hołowiecka B, Walewski J, Charliński G, Jędrzejczak WW, Wiater E, Lech-Marańda E, Mańko J, Dytfeld D, Komarnicki M, Jamroziak K, Robak T, Jurczyszyn A, Skotnicki A, Giannopoulos K. Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2013. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.achaem.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Leung N, Behrens J. Current approach to diagnosis and management of acute renal failure in myeloma patients. Adv Chronic Kidney Dis 2012; 19:297-302. [PMID: 22920640 DOI: 10.1053/j.ackd.2012.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/22/2012] [Accepted: 06/14/2012] [Indexed: 11/11/2022]
Abstract
Renal impairment is a serious complication of multiple myeloma. The primary cause of renal failure in myeloma is damage to the kidney by excessive amounts of light chain produced by the myeloma tumor, giving rise to cast nephropathy (myeloma kidney), although there are several other important precipitants. Significantly poor prognosis is observed in patients who do not recover their renal function; however, with the advent of more effective therapies and a greater understanding of the pathogenesis of the underlying process, it has become possible to reverse renal impairment in greater numbers of patients. Determining whether the renal impairment is due to cast nephropathy should be the first priority, and once the diagnosis is confirmed, appropriate treatment should be initiated without delay. Reduction of serum free light chain is the key to recovery of renal function in these patients. The role of chemotherapy and extracorporeal removal of light chain are discussed.
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