Resolution of cast nephropathy following free light chain removal by haemodialysis in a patient with multiple myeloma: A case report

被引：15

作者：

Basnayake K. ^{[1
]}

Hutchison C. ^{[1
]}

Kamel D. ^{[1
]}

Sheaff M. ^{[2
]}

Ashman N. ^{[2
]}

Cook M. ^{[1
]}

Oakervee H. ^{[2
]}

Bradwell A. ^{[3
]}

Cockwell P. ^{[1
]}

机构：

[1] Queen Elizabeth Medical Centre, University Hospital Birmingham, Birmingham B15 2TH, Edgbaston

[2] Barts and the London NHS Trust, London E1 1BB, Whitechapel

[3] Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, Edgbaston

来源：

Journal of Medical Case Reports | / 2卷 / 1期

关键词：

Multiple Myeloma; Acute Renal Failure; Free Light Chain; Cast Formation; Serum Free Light Chain;

D O I：

10.1186/1752-1947-2-380

中图分类号：

学科分类号：

摘要：

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 concentrations fall, intratubular casts may resolve within weeks. Case presentation: We report the case of a 61-year-old Caucasian woman who presented with multiple myeloma and dialysis-dependent acute renal failure, with serum kappa free light chain concentrations of 15,700 mg/ litre (normal range 3.3 to 19.4 mg/litre). Renal biopsy demonstrated cast nephropathy with waxy casts in distal tubules and collecting ducts. There was an interstitial inflammatory cell infiltrate with diffuse fibrosis and tubular atrophy. Following rehydration, chemotherapy and free light chain removal using high cut-off haemodialysis, free light chain concentrations fell to less than 5% of the starting level (500 mg/ litre). A repeat renal biopsy 6 weeks after the first showed resolution of cast nephropathy. Conclusion: These observations indicate that cast nephropathy can quickly resolve on rapid reduction of monoclonal serum free light chains. This has important implications for the development of treatment strategies aimed at improving renal recovery rates for patients in this setting. © 2008 Basnayake et al; licensee BioMed Central Ltd.

引用

共 15 条

[1]

Knudsen L.M., Hjorth M., Hippe E., Knudsen L.M., Hjorth M., Hippe E., Renal failure in multiple myeloma: Reversibility and impact on the prognosis, Eur J Haematol, 65, pp. 175-181, (2000)

[2]

Torra R., Blade J., Cases A., Lopez-Pedret J., Montserrat E., Rozman C., Revert L., Patients with multiple myeloma requiring long-term dialysis: Presenting features, response to therapy, and outcome in a series of 20 cases, Br J Haematol, 91, pp. 854-859, (1995)

[3]

Herrera G.A., Joseph L., Gu X., Hough A., Barlogie B., Renal pathologic spectrum in an autopsy series of patients with plasma cell dyscrasia, Arch Pathol Lab Med, 128, pp. 875-879, (2004)

[4]

Sanders P.W., Booker B.B., Bishop J.B., Cheung H.C., Mechanisms of intranephronal proteinaceous cast formation by low molecular weight proteins, J Clin Invest, 85, pp. 570-576, (1990)

[5]

Sanders P.W., Booker B.B., Pathobiology of cast nephropathy from human Bence Jones proteins, J Clin Invest, 89, pp. 630-639, (1992)

[6]

Rose P.E., McGonigle R., Michael J., Boughton B.J., Renal failure and the histopathological features of myeloma kidney reversed by intensive chemotherapy and peritoneal dialysis, Br Med J (Clin Res Ed), 294, pp. 411-412, (1987)

[7]

Hutchison C.A., Cockwell P., Reid S., Chandler K., Mead G.P., Harrison J., Hattersley J., Evans N.D., Chappell M.J., Cook M., Et al., Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: In vitro and in vivo studies, J Am Soc Nephrol, 18, pp. 886-895, (2007)

[8]

Bradwell A.R., Carr-Smith H.D., Mead G.P., Tang L.X., Showell P.J., Drayson M.T., Drew R., Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine, Clin Chem, 47, pp. 673-680, (2001)

[9]

Katzmann J.A., Clark R.J., Abraham R.S., Bryant S., Lymp J.F., Bradwell A.R., Kyle R.A., Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: Relative sensitivity for detection of monoclonal light chains, Clin Chem, 48, pp. 1437-1444, (2002)

[10]

Cheson B.D., De Bellis C.C., Schumann G.B., Schumann J.L., Cheson B.D., De Bellis C.C., Schumann G.B., Schumann J.L., The urinary myeloma cast. Frequency of detection and clinical correlations in 30 patients with multiple myeloma, Am J Clin Pathol, 83, pp. 421-425, (1985)

← 1 2 →