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Zhang Y, Pan J, Kang H, Peng S, Tung TH, Shen B. Prognosis of concurrent renal impairment at diagnosis of multiple myeloma: a systematic review. Ann Med 2024; 56:2380301. [PMID: 39034813 PMCID: PMC11265304 DOI: 10.1080/07853890.2024.2380301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/27/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Multiple myeloma is a malignant tumour of the blood in which abnormal proliferation of plasma cells leads to bone destruction, renal impairment, anaemia, and hypercalcaemia. Renal impairment caused by multiple myeloma is a common and serious condition; however, the prognosis of multiple myeloma at the time of diagnosis remains unclear. METHOD We conducted searches for literature in PubMed, Web of Science, Cochrane, Embase, CNKI, Wanfang, and VIP databases up to 30 April 2023. Progression-free survival and overall survival with and without renal impairment at the time of multiple myeloma diagnosis were compared, and prognostic indicators were analysed. RESULTS Six studies were finally included. Among patients with multiple myeloma, 319 had renal impairment, and 1166 had no renal impairment. Compared to the control group, no significant difference was observed in overall or progression-free survival in patients with multiple myeloma complicated with renal impairment. CONCLUSION The limited low-quality evidence available does not support an association between prognosis and multiple myeloma complicated by kidney injury.
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Affiliation(s)
- Yanjie Zhang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Juan Pan
- Department of Clinical Laboratory, Taizhou Hospital, Zhejiang University, Linhai, China
| | - Haixin Kang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Shuotao Peng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Bo Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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Razzouk R, Khattab N, Hoteit M, Kfoury H, Saleh M, Tanios B, El-Cheikh J, Mallat S. A rare case of IgA lambda multiple myeloma in a 32-year-old woman with t(14;16) translocation associated with kidney injury and non-albumin proteinuria. BMC Nephrol 2024; 25:165. [PMID: 38755555 PMCID: PMC11100155 DOI: 10.1186/s12882-024-03600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a malignant disorder characterized by monoclonal differentiated plasma cells. While it is more commonly diagnosed in elderly individuals, it can also affect younger populations, though with a lower incidence. CASE PRESENTATION Here, we present the case of a 32-year-old woman diagnosed with IgA lambda MM. She presented with fatigue, nausea, acute kidney injury (AKI) with a rapid increase in creatinine, and anemia. A kidney biopsy was done to rule out a rapidly progressive glomerular disease and a diagnosis was thus reached. A genetic workup revealed t(14;16) translocation and an extra copy of TP53. The patient received aggressive intravenous steroids and intravenous fluid resuscitation, resulting in an improvement in renal function. Treatment with daratumumab in combination with bortezomib, thalidomide, and dexamethasone was initiated and well tolerated. Despite the generally poor prognosis of IgA MM, our case emphasizes the importance of considering MM in young patients with unexplained kidney injury. CONCLUSION Early recognition and prompt intervention are essential in managing MM patients, especially in those with high-risk cytogenetic abnormalities. This case serves as a reminder for clinicians to maintain a high index of suspicion for MM, even in younger populations, when presented with unexplained kidney injury.
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Affiliation(s)
- Ranim Razzouk
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Khattab
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maysaa Hoteit
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Kfoury
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mustafa Saleh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Tanios
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El-Cheikh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samir Mallat
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, Lebanon.
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Lee H, Liu KH, Yang YH, Liao JD, Lin BS, Wu ZZ, Chang AC, Tseng CC, Wang MC, Tsai YS. Advances in uremic toxin detection and monitoring in the management of chronic kidney disease progression to end-stage renal disease. Analyst 2024; 149:2784-2795. [PMID: 38647233 DOI: 10.1039/d4an00057a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Patients with end-stage kidney disease (ESKD) rely on dialysis to remove toxins and stay alive. However, hemodialysis alone is insufficient to completely remove all/major uremic toxins, resulting in the accumulation of specific toxins over time. The complexity of uremic toxins and their varying clearance rates across different dialysis modalities poses significant challenges, and innovative approaches such as microfluidics, biomarker discovery, and point-of-care testing are being investigated. This review explores recent advances in the qualitative and quantitative analysis of uremic toxins and highlights the use of innovative methods, particularly label-mediated and label-free surface-enhanced Raman spectroscopy, primarily for qualitative detection. The ability to analyze uremic toxins can optimize hemodialysis settings for more efficient toxin removal. Integration of multiple omics disciplines will also help identify biomarkers and understand the pathogenesis of ESKD, provide deeper understanding of uremic toxin profiling, and offer insights for improving hemodialysis programs. This review also highlights the importance of early detection and improved understanding of chronic kidney disease to improve patient outcomes.
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Affiliation(s)
- Han Lee
- Laboratory of Engineered Materials for Biomedical Applications, Department of Materials Science and Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
| | - Kuan-Hung Liu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - Yu-Hsuan Yang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - Jiunn-Der Liao
- Laboratory of Engineered Materials for Biomedical Applications, Department of Materials Science and Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
| | - Bo-Shen Lin
- Laboratory of Engineered Materials for Biomedical Applications, Department of Materials Science and Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
| | - Zheng-Zhe Wu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - Alice Chinghsuan Chang
- Center for Measurement Standards, Industrial Technology Research Institute, No. 321, Kuang Fu Road, Section 2, Hsinchu 300, Taiwan.
| | - Chin-Chung Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - Yau-Sheng Tsai
- Center for Clinical Medicine Research, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
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Chili LH, Mackraj I, Rapiti N. Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0287304. [PMID: 37878638 PMCID: PMC10599510 DOI: 10.1371/journal.pone.0287304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/03/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To profile the outcome of multiple myeloma (MM) patients treated at a South African tertiary hospital in KwaZulu-Natal (KZN) and to compare MM in HIV-negative patients and MM in people living with HIV (PLWH). METHODS A retrospective analysis of patients with MM was conducted over 5 years (2015-2020). Patient demographics, presenting complaints, symptom duration, disease stage, molecular profile, treatment, and survival data were captured. Statistical analysis was conducted using R Statistical software of the R Core Team, 2020, version 3.6.3. RESULTS 135 patients; 79% (n = 106) HIV-negative and 21% (n = 29) PLWH were investigated. 54% (n = 74) females and 57% (n = 76) 51-70-year-olds. The 40-50-year-old patient group had a significantly higher proportion of PLWH (p = 0.032). Pathological fractures were the commonest presenting complaint, 47% (n = 57 and 49% (n = 49) had International Staging System, stage III disease. Fluorescent in-situ hybridization (FISH) MM profiling was completed in 58% (n = 78). Positivity for del 11q22 was found in 23.7% (n = 14) with significantly more HIV-negative patients having the mutation (p = 0.027). Overall, 42.2% (n = 57) achieved 2-year overall survival (OS). There were no significant differences in treatment (p = 0.926) and 2-year survival outcome (p = 0.792) between the two groups. CONCLUSION The incidence of HIV in newly diagnosed MM patients in KZN was increasing. KZN patient profile differed from other reports by showing female predominance but was similar in advanced-stage presentation and bone fracture predominance. Statistically significant differences between the HIV-negative patients and PLWH were observed in age distribution and mutational landscape. Further studies are required in this area.
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Affiliation(s)
- Lungisile Hildegard Chili
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Haematology Department, National Health Laboratory Services, Durban, KwaZulu-Natal, South Africa
| | - Irene Mackraj
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
| | - Nadine Rapiti
- Haematology Department, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
- Haematology Department, National Health Laboratory Services, Durban, KwaZulu-Natal, South Africa
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Almuhaysen LM, Alaa ABAA. A Study on Renal Failure Management in Patients Diagnosed With Multiple Myeloma. Cureus 2023; 15:e47460. [PMID: 38022312 PMCID: PMC10660674 DOI: 10.7759/cureus.47460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Renal impairment, often occurring as a result of multiple myeloma, poses a significant risk to patient health and quality of life. Therefore, the study was conducted with the objective of investigating the management of renal failure in patients diagnosed with multiple myeloma in Saudi Arabia. METHODS A retrospective observational study was conducted during the period from January to August 2023 for the duration of eight months. The data were collected from the patients diagnosed with multiple myeloma, available from the medical records of Prince Sultan Military Medical City, Saudi Arabia. RESULTS The data were collected from a cohort of 85 patients with multiple myeloma. Among patients, males were 62 (72.94%), and females were 23 (27.06%). The mean (SD) age was 68.43 (7.24) years. Among the cohort, 42 (49.1%) were International Staging System (ISS) stage III, and 32 (37.6%) were light chain myeloma. Most patients underwent novel agent-based treatment regimens (a combination of immunomodulator, proteasome inhibitor, and monoclonal antibody; 59, 69.41%), followed by conventional therapy; 16, 18.82%). Multivariate analysis of patient survival showed significant associations with three variables: increased calcium level (P=0.007), eGFR <30 mL/min (P=0.004), and novel agent induction (P=0.001). CONCLUSION This study sheds light on the intricate management of renal failure in multiple myeloma patients, specifically within the Saudi population. The observed associations between survival and various variables emphasize the critical role of renal function in overall patient outcomes.
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Cosmai L, Gallieni M. High-Cutoff Hemodialysis Therapy for Patients with Light Chain Cast Nephropathy and AKI Requiring Dialysis: Commentary. KIDNEY360 2023; 4:1027-1029. [PMID: 37212744 PMCID: PMC10476673 DOI: 10.34067/kid.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Laura Cosmai
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
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