Aggregated serum free light chains may prevent adequate removal by high cut-off haemodialysis.
نویسندگان
چکیده
Free light chain (FLC) removal by high cut-off haemodialysis has been described as an adjuvant therapy for the management of patients with severe renal failure complicating multiple myeloma. The two cases reported here are the first patients in whom this treatment did not remove FLCs. In both patient's sera, size-exclusion chromatography identified large FLC aggregates, with molecular weights above the cut-off of the dialyser. It is important for clinicians to be aware of FLC aggregates as a reason for failure to remove FLCs by this new modality.
منابع مشابه
European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): A randomised control trial
BACKGROUND Renal failure is a frequent complication of multiple myeloma and when severe is associated with a greatly increased morbidity and mortality. The principal cause of severe renal failure is cast nephropathy, a direct consequence of high concentrations of monoclonal free light chains (FLCs) in patients' sera. FLC removal by extended haemodialysis, using a high cut-off dialyser, has rece...
متن کاملResolution of cast nephropathy following free light chain removal by haemodialysis in a patient with multiple myeloma: a case report
INTRODUCTION Acute renal failure in multiple myeloma is most frequently caused by cast nephropathy, when excess monoclonal free light chains co-precipitate with Tamm-Horsfall protein in the distal nephron, causing tubular obstruction. The natural history of cast nephropathy after diagnosis is unknown. This report provides supporting histological evidence that, as serum free light chain concentr...
متن کاملCast nephropathy with acute renal failure treated with high cut-off haemodialysis in a patient with multiple myeloma.
We report a case of a Chinese woman who presented with multiple myeloma and acute renal failure due to cast nephropathy, with an extremely high serum lambda free light chain concentration. She was successfully treated with chemotherapy and high cut-off extended haemodialysis. High cut-off haemodialysis is a new treatment modality which can achieve rapid free light chain clearance. This may cont...
متن کاملComment on "Haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma".
INTRODUCTION Acute renal failure (ARF) occurs in 12%-20% of all multiple myeloma (MM) cases, and the survival of these patients depends on renal function recovery. Renal function is not recovered in 75% of dialysis-dependent patients, and their mean survival with replacement therapy is less than one year. Renal tubular disease is the most frequent cause of renal failure. It is present in more t...
متن کاملMultiple myeloma and high cut-off haemodialysis: On the right track for better outcomes?
Background: Acute kidney injury secondary to cast nephropathy is a common complication of multiple myeloma. Extracorporeal light chain elimination by high cut-off haemodialysis has been described as an adjuvant to effective chemotherapy to limit free light chain toxicity. The purpose of this study was to evaluate the impact of high cut-off haemodialysis and bortezomib-based chemotherapy on rena...
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عنوان ژورنال:
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
دوره 26 4 شماره
صفحات -
تاریخ انتشار 2011