Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: a position statement of the Onconephrology Work Group of the Italian Society of Nephrology

2016 ◽  
Vol 29 (6) ◽  
pp. 735-746 ◽  
Author(s):  
P. Fabbrini ◽  
K. Finkel ◽  
M. Gallieni ◽  
G. Capasso ◽  
M. Cavo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Work Group ◽  
Kidney Injury ◽  
Position Statement ◽  
Italian Society ◽  
Light Chains

scholarly journals Haemodiafiltration with ultrafiltrate regeneration in the removal of free light chains in multiple myeloma and acute kidney injury

Nefrología ◽  
2018 ◽  
Vol 38 (3) ◽  
pp. 337-338
Author(s):  
Gioacchino Li Cavoli ◽  
Silvia Passanante ◽  
Onofrio Schillaci ◽  
Franca Servillo ◽  
Carmela Zagarrigo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Light Chains ◽  
Free Light Chains

scholarly journals Haemodiafiltration with ultrafiltrate regeneration in the removal of free light chains in multiple myeloma and acute kidney injury

2018 ◽  
Vol 38 (3) ◽  
pp. 337-338
Author(s):  
Gioacchino Li Cavoli ◽  
Silvia Passanante ◽  
Onofrio Schillaci ◽  
Franca Servillo ◽  
Carmela Zagarrigo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Light Chains ◽  
Free Light Chains

scholarly journals SP253A NEW STRATEGY TO REMOVE SERUM FREE LIGHT CHAINS(SFLC)IN PATIENTS WITH MULTIPLE MYELOMA (MM) AND ACUTE KIDNEY INJURY (AKI)

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii462-iii462
Author(s):  
Francescaromana Festuccia ◽  
Elisa Giammarioli ◽  
Claudia Fofi ◽  
Giusy Antolino ◽  
Giacinto La Verde ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
New Strategy ◽  
Serum Free Light Chains

scholarly journals P0631COMPLICATIONS OF TREATMENT WITH HIGH CUT OFF FILTERS FOR ACUTE KIDNEY INJURY SECONDARY TO MULTIPLE MYELOMA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
ANA BERNI WENNEKERS ◽  
Ana Coscojuela Otto ◽  
MARIA VICTORIA DOURDIL ◽  
PABLO IÑIGO GIL ◽  
Rafael Alvarez Lipe
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Human Albumin ◽  
Infectious Complications ◽  
Light Chains ◽  
Dialysis Session ◽  
Daily Dialysis ◽  
Febrile Episodes ◽  
Conventional Hemodialysis

Abstract Background and Aims Acute kidney injury is a frequent complication of MM that can affect 18 to 56% of patients and more than 10% end up needing dialysis. One of the drawbacks associated with the technique is attributed to the albumin loss. The other complications are related with the dialysis technique itself, especially infections, as highlighted by the Eulite study. The objective of the study is to check that there are no more complications in dialysis with High Cut Off filters than in conventional Hemodialysis. Method We are the referral hospital in our community in the treatment of acute kidney injury secondary to myeloma. We have performed 28 treatments of hemodialysis with High cut off filters (HD-HCO). The HD-HCO protocol includes daily dialysis session of 6 hours during the first 6 days to subsequently switch to dialysis every other dayuntil free light chains levels below 500 mg/L, or until the recovery of renal function allows the independence of dialysis. All these patients have a chemotherapy regimen based on Bortezomib (25 of the 28 treatments) and Dexamethasone (28 treatments). A retrospective analysis of the 28 treatments that are performed with HD-HCO after 8 years of experience (July 2011 to May 2019) to demostrate the presence of the same complications as the conventional Hemodialysis. Results Loss of albumin is one of the main drawbacks of the technique. Our patients had no changes in albumin levels due to the fact that our protocol includes the infusion of 2 vials of 20% albumin of 50 ml. at the end of each HD-HCO session. Figure 2 Another concern is intradialytic complications. We have reviewed this topic and our results show that patients in HD-HCO do not present a greater number of complications than those who dialyze with HD-HD or other conventional dialysis. The total number of sessions was 298. 21 patients developed hypotension (7%). The number of sessions in which the patient presented fever was 6 (2%), coagulation of the circuit occurred in 23 sessions (7,7%). The catheter dysfunction (when it does not allow to reach 250 ml/min of blood flow) in 26 times(8.7%) and only 13 times the replacement of the catheter (4.26%) was necessary, consequently, in those who required a greater number of dialysis sessions. In only 1 case (patient who required 27 sessions) to place a permanent Tesio catheter was necessary. Figure 1 In referring to complications of dialysis for AKI secondary to myeloma, few studies consider them. These studies focus on quantifying the reduction of light chains and the efficiency of the treatment, but don’t keep in mind the record of the complications. In the EuLITE study, authors observed a greater number of lung infections in the HD-HCO group (12 vs 3) p = 0.014 and attributed this difference to extended dialysis and albumin loss.We have not observed this problem. The levels of albumin are stable with our infusion protocol of 2 vials of 20% human albumin of 50 ml at the end of each HD-HCO. There’s no more complications than conventional dialysis, even infection ones. 13 febrile episodes occurred in 6 patients (more than 37,5ºC). Blood cultures were collected in all patients, being positive in only 4 patients. Germs found were: Escherichia coli (treated with Amoxicilin/clavulanic), Staphylococcus aureus (treated with Daptomycin), Staphylococcus epidermidis (treated with Meropenem) and Klebsiella pneumoniae (treated with Meropenem too). This 4 patients were the ones who required the replacement of the catheter. Conclusion 1. - Our findings indicate that the HD-HCO has the same safety profile as the conventional Hemodialysis. 2.- There is no serious infectious complications in our patients despite of the fact that all of them are immunosuppressed patients (AKI secondary to Multiple Myeloma in patients treated with chemotherapy)

scholarly journals Serum Free Light Chains Removal by HFR Hemodiafiltration in Patients with Multiple Myeloma and Acute Kidney Injury: a Case Series

2018 ◽  
Vol 43 (4) ◽  
pp. 1263-1272 ◽  
Author(s):  
Paolo Menè ◽  
Elisa Giammarioli ◽  
Claudia Fofi ◽  
Giusy Antolino ◽  
Giacinto La Verde ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Case Series ◽  
Kidney Injury ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

MO670EXPANDED HEMODIALYSIS REDUCES THE CONCENTRATION OF FREE LIGHT CHAINS IN PATIENTS WITH ACUTE KIDNEY INJURY IN MYELOMA CAST NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Konstantin Vishnevskii ◽  
Olga Domashenko
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Average Concentration ◽  
High Flow ◽  
Low Flow ◽  
Light Chains ◽  
Free Light Chains ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy

Abstract Background and Aims The myeloma cast nephropathy is largely associated with the production of intact immunoglobulin and free light chains (FLC) by a plasma cells monoclone. The use of high-flux hemodiafiltration (HDF) contributes to a decrease in the concentration of FLC. However, it is not always possible to achieve the required substitute volume with acute kidney injury (AKI) emergency treatment. An alternative to HDF could be the usage of membranes with a medium cut-off (expanded hemodialysis (HD), Expanded HD). The aim of this study was to compare the degree of reduction in FLC concentration using conventional HD, HDF and Expanded HD. Method The study includes patients with newly diagnosed multiple myeloma who presented indications for HD therapy start. Procedures were performed on a daily basis from the moment when indications for HD therapy were identified. The duration of the first three procedures was 2 hours. Consistently for each patient the first procedure was carried out using a standard low-flow filter, the second - using a high-flow dialyzer and HDF (substitute volume 9 liters for 2 hours), the third - using a Theranova 400 filter (Baxter, Germany). The concentrations of FLC (kappa and lambda) and albumin were determined every 30 minutes of each treatment. Chemotherapy was prescribed according to the local clinical recommendations in combination with the ongoing renal replacement therapy. Results The study included 7 patients with cast nephropathy, mean age 68±8 years. Average concentration before treatment: kappa FLC 876±727 μg/ml (norm 3.25-15.81 μg/ml), lambda FLK 84±112 μg/ml (norm 3.23-28.05 μg/ml), albumin 34±1 g/l (norm 40-50 g/l). After 2 hours of treatment, there was a decrease in kappa FLC concentration with HDF (-34±33%, p=0.01) and with Expanded HD (-31±12%, p<0.001), but not with conventional HD (-1±7, p=0.79, Fig 1). The lambda FLC concentration also decreased with HDF (-41±29%, p=0.01) and with Expanded HD (-28±22%, p=0.01), but not with conventional HD (-3±12, p=0.65, Fig 2). Albumin concentrations did not change significantly with any of the treatments. Conclusion Expanded HD, as well as high-flow HDF, helps to reduce the FLC concentration in patients with cast nephropathy without loss of albumin, which may have a positive effect on the multiple myeloma prognosis. Further studies are needed regarding possibilities of using Expanded HD in the complex therapy for patients with AKI in myeloma cast nephropathy.

scholarly journals Multiple myeloma can be accurately diagnosed in acute kidney injury patients using a rapid serum free light chain test

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Jennifer L. J. Heaney ◽  
John P. Campbell ◽  
Punit Yadav ◽  
Ann E. Griffin ◽  
Meena Shemar ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Light Chain ◽  
Kidney Injury ◽  
Free Light Chain ◽  
Serum Free ◽  
Serum Free Light Chain
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