scholarly journals Renal involvement as the first symptom of multiple myeloma

2019 ◽  
Author(s):  
Yongjing Du ◽  
Ping Zhang ◽  
Xiang Zhong ◽  
Shasha Chen ◽  
Guisen Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Light Chain ◽  
Clinical Laboratory ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Renal Amyloidosis ◽  
Cast Nephropathy ◽  
Light Chain Disease ◽  
Immunofixation Electrophoresis

Abstract Background Renal involvement is a common complication of multiple myeloma (MM). However, most studies have focused on renal failure in MM, and little information is available about the other renal manifestations in MM and their association with immunophenotypes and renal pathology. Methods We retrospectively analyzed the clinical, laboratory and pathology data of 283 MM patients treated in Sichuan Provincial People’s Hospital, West China, between January 1990 and May 2017. The patients were divided into a renal involvement group (n = 200) and a non-renal involvement group (n = 83). Results In the renal involvement group, 90 (45.0%) patients were diagnosed with MM in the Nephrology department, and isolated proteinuria, renal failure and nephrotic syndrome were detected in 90(45.0%), 94 (47.0%) and 53 (27.0%) patients, respectively. 135 patients with renal involvement underwent immunofixation electrophoresis, and IgG, IgA, IgD, IgE, pure light chain and nonsecretory MM were detected in 52 (38.5%), 32 (23.7%), 1 (0.7%), 1 (0.7%), 45(33.3%) and 4 (3.0%) patients, respectively. 47 patients without renal involvement also underwent immunofixation electrophoresis, and IgG and IgA MM were found in 24 (51.0%) and 18 (38.3%) patients, respectively. Severe anemia and hypertension, hypercalcemia and pure light chain disease were more frequent in patients with renal involvement (P < 0.05). 9 patients with renal involvement were performed renal biopsy, and cast nephropathy and renal amyloidosis were proved in 5(55.6%) and 4(44.4%) patients, respectively. Conclusions Renal involvement was common at MM diagnosis and had diverse clinical manifestations. Nephrologists should rule out MM in patients presenting with renal involvement.

scholarly journals Renal involvement as the first symptom of multiple myeloma

2019 ◽  
Author(s):  
Yongjing Du ◽  
Ping Zhang ◽  
Xiang Zhong ◽  
Shasha Chen ◽  
Guisen Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Nephrotic Syndrome ◽  
Light Chain ◽  
Clinical Laboratory ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Renal Amyloidosis ◽  
Cast Nephropathy ◽  
Immunofixation Electrophoresis

Abstract Background . Renal involvement is a common complication of multiple myeloma (MM). However, most studies have focused on renal failure in MM, and little information is available about the other renal manifestations in MM and their association with immunophenotypes and renal pathology. Methods . We retrospectively analyzed the clinical, laboratory and pathology data of 283 MM patients treated in Sichuan Provincial People’s Hospital, West China, between January 1990 and May 2017. The patients were divided into a renal involvement group (n = 200) and a non-renal involvement group (n = 83). Results. In the renal involvement group, 90 (45.0%) patients were diagnosed with MM in the Nephrology department, and isolated proteinuria, renal failure and nephrotic syndrome were detected in 90(45.0%), 94 (47.0%) and 58 (29.0%) patients, respectively. 135 patients with renal involvement underwent immunofixation electrophoresis, and IgG, IgA, IgD, IgE, pure light chain and nonsecretory MM were detected in 52 (38.5%), 32 (23.7%), 1 (0.7%), 1 (0.7%), 45(33.3%) and 4 (3.0%) patients, respectively. 47 patients without renal involvement also underwent immunofixation electrophoresis, and IgG and IgA MM were found in 24 (51.0%) and 18 (38.3%) patients, respectively. Severe anemia and hypertension, hypercalcemia and pure light chain were more frequent in patients with renal involvement (P < 0.05).9 patients with renal involvement were performed renal biopsy, and cast nephropathy, renal amyloidosis were proved in 5 and 4 patients, respectively. Conclusions. Renal involvement was common at MM diagnosis and had diverse clinical manifestations. The most common clinical manifestations include renal failure, isolated albuminuria and nephrotic syndrome. Nephrologists should rule out MM in patients presenting with renal involvement.

P1114HA-130 HEMOPERFUSION CARTRIDGE IN THE TREATMENT OF CAST NEPHROPATHY IN A 58-YEAR-OLD MALE WITH MULTIPLE MYELOMA: A CASE REPORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Joanna Margarita Santos ◽  
Maria Kristina L Alolod
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Case Report ◽  
Light Chain ◽  
Free Light Chain ◽  
Light Chains ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Cast Nephropathy ◽  
History Of

Abstract Background and Aims Multiple myeloma is a plasma cell neoplasm that results in the production of monoclonal immunoglobulin. Renal failure is a common complication of multiple myeloma, occurring in approximately one-half of patients on initial presentation and is associated with increased mortality. Cast nephropathy in particular, is considered to be one of the major mechanisms of renal failure in multiple myeloma, and is characterized by precipitation of free light chains in the distal nephron, leading to intratubular obstruction, inflammation and fibrosis. Recent studies have demonstrated the use of extracorporeal methods such as plasmapheresis and high-cutoff membrane dialysis as an adjunctive therapy to chemotherapy in the management of cast nephropathy, however currently there are no existing guidelines in the use of extracorporeal therapies in the management of complications of multiple myeloma. Hemoperfusion is an extracorporeal treatment technique which utilizes adsorption in the removal of specific toxins. The HA 130 cartridge in particular has a resin pore size distribution of 500Da- 40 KDa and is able to remove molecules at 5-30kDa. In this case report we describe the use of HA 130 hemoperfusion cartridge in the treatment of cast nephropathy in Multiple Myeloma. Method A 58-year-old male, diabetic, non-hypertensive came in for 5-day history of generalized body weakness, associated with myalgia, lumbar pain and undocumented fever, with 1-day history of loose stools and vomiting. Upon admission blood tests done revealed anemia with a hemoglobin of 7.8g/dl, creatinine of 9.97mg/dL and potassium of 5.5mmol/L. He was diagnosed with acute renal failure and underwent hemodialysis on the second hospital day. On workup he had lytic bone lesions in the spine, pelvis and cranium on CT scan and x-ray. Serum Protein Electrophoresis (SPEP) and Serum Free Light Chain (sFLC) tests showed a monoclonal gammopathy. Serum beta 2 microglobulin was elevated at 12,618ng/ml. Free kappa and lambda light chains were also elevated at 19,250mg/L and 25.7mg/L, respectively. Bone marrow biopsy was done, with findings of markedly hypercellular marrow with 80% plasma cells confirming the diagnosis of Multiple Myeloma. Combined hemodialysis with hemoperfusion were done using HA 130 filter and hi flux dialyzer for 2.5 hours then hemodialysis for three times a week. Patient was also started on chemotherapy using Bortezomib with Dexamethasone for 2 cycles. Results Patient had a total of 14 sessions of combined hemoperfusion with hemodialysis. On repeat free kappa light chains decreased to 212.5mg/L. Patient was maintained on hemodialysis three times a week and was discharged after 55 hospital days. Outpatient hemodialysis was continued three times a week, and after 2 weeks, patient showed signs of renal recovery with a repeat creatinine of 2.1mg/dL. Four weeks after discharge, patient was independent of hemodialysis with a repeat creatinine of 1.3mg/dL. Conclusion This report highlights the use of hemoperfusion using HA 130 cartridge in combination with chemotherapy using Bortezomib in reducing free light chain levels in a 58-year-old male that developed renal failure secondary to cast nephropathy. Patient was able to achieve reduction in free light chain levels, improvement in renal function and eventually independence from hemodialysis four weeks after the last hemoperfusion treatment. Further studies using a randomized control trial on the use of hemoperfusion in directly reducing serum free light chain levels is recommended. The value of hemoperfusion on the rate of independence from hemodialysis, as well as survival rates among patients with renal failure secondary to multiple myeloma may also be worth investigating using larger studies.

scholarly journals A Case of Multiple Myeloma Diagnosed by Renal Biopsy

2016 ◽  
Vol 14 (2) ◽  
pp. 89-91
Author(s):  
Lutfiye Bilge Caliskan ◽  
Tugba Karadeniz ◽  
Sumeyye Ekmekci ◽  
Banu Yilmaz Avcioglu ◽  
Mehmet Tanrisev ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Clinical Case ◽  
Bone Fractures ◽  
Cell Clone ◽  
Clinical Manifestations ◽  
Peripheral Blood Smear ◽  
Laboratory Findings ◽  
Cast Nephropathy

Abstract Multiple myeloma is a malignant disease that results in the proliferation of a single plasma cell clone. The clinical manifestations are anemia, bone pain, bone fractures, hypercalcemia, hypergammaglobulinemia, increased erythrocyte sedimentation rate, rouleaux formation on the peripheral blood smear and rarely increased serum viscosity. Rarely cast nephropathy associated with acute renal failure may be the first finding of multiple myeloma. We report a clinical case of a 44-year-old female patient who presented with acute renal failure due to cast nephropathy without myeloma’s typical clinical and laboratory findings. In the clinical case presented here, we highlight that multiple myeloma can be presented with acute renal failure and without any other typical symptoms.

scholarly journals Monitoring IgA Multiple Myeloma: Immunoglobulin Heavy/Light Chain Assays

2015 ◽  
Vol 61 (2) ◽  
pp. 360-367 ◽  
Author(s):  
Jerry A Katzmann ◽  
Maria A V Willrich ◽  
Mindy C Kohlhagen ◽  
Robert A Kyle ◽  
David L Murray ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Clinical Laboratory ◽  
Reference Interval ◽  
Reference Intervals ◽  
Additional Advantage ◽  
Immunofixation Electrophoresis ◽  
Diagnostic Samples ◽  
M Spike ◽  
Monoclonal Proteins

Abstract BACKGROUND The use of electrophoresis to monitor monoclonal immunoglobulins migrating in the β fraction may be difficult because of their comigration with transferrin and complement proteins. METHODS Immunoassays specific for IgGκ, IgGλ, IgAκ, IgAλ, IgMκ, and IgMλ heavy/light chain (HLC) were validated for use in the clinical laboratory. We assessed sample stability, inter- and intraassay variability, linearity, accuracy, and reference intervals for all 6 assays. We tested accuracy by verifying that the sum of the concentrations for the HLC-pairs accounted for the total immunoglobulins in each of 129 healthy sera, and that the HLC-pair ratios (rHLCs) were outside the reference interval in 97% of 518 diagnostic multiple myeloma (MM) samples. RESULTS We assessed diagnostic samples and posttreatment sera in 32 IgG and 30 IgA patients for HLC concentrations, rHLC, and total immunoglobulins and compared these nephelometry results with serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). In sample sets from patients with IgG MM, the sensitivity of SPEP was almost the same as for rHLC, and no additional advantage was conferred by running HLC assays. In pre- and posttreatment samples from patients with IgA MM, the SPEP, rHLC, and IFE identified clonality in 28%, 56%, and 61%, respectively. In addition, when M-spikes were quantifiable, the concentration of the involved HLC was linearly related to that of the SPEP M-spike, with a slope near 1. CONCLUSIONS The use of IgA HLC assays for monitoring β-migrating IgA monoclonal proteins can substitute for the combination of SPEP, IFE, and total IgA quantification.

Immunoassays for IgG and IgA Light Chain Pairs Are More Sensitive Than Immunofixation Electrophoresis in Multiple Myeloma and Provide Quantitative Analysis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5109-5109
Author(s):  
Arthur R. Bradwell ◽  
Graham Mead ◽  
Mark T Drayson ◽  
Stephen Harding
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Clinical Utility ◽  
Clinical Laboratory ◽  
Residual Disease ◽  
Rank Test ◽  
Serum Free Light Chain ◽  
Kaplan Meier ◽  
Normal Ranges ◽  
Immunofixation Electrophoresis

Abstract Introduction: Serum free light chain (sFLC) measurements are having a big impact in the diagnosis and monitoring of patients with monoclonal gammopathies. Utility is largely dependent upon assessing FLC kappa/lambda (κ/λ) ratios as the determinant of tumor clonality. To date, intact immunoglobulin measurements comprise total IgG, IgA and IgM, the measurement of bands on gels by serum protein electrophoresis (SPE) or immunofixation electrophoresis (IFE). We hypothesised that analysis of intact immunoglobulin molecules for their light chain content and light chain ratios might be clinically useful in patients with multiple myeloma (MM). Methods: Monospecific polyclonal antisera were produced against IgGκ, IgGλ, IgAκ and IgAλ, using a combination of tolerisation and affinity chromatography. The four reagents reacted only with conformational epitopes that spanned the quaternary junctional regions between bound κ or λ light chains and their respective heavy chain partners. Antisera were then tailored for use as nephelometric homogeneous immunoassays on a Siemens Dade-Behring BN™II clinical laboratory analyser. Reagents were assessed for normal ranges (using blood donor sera) and clinical utility in IgG and IgA MM sera. Results: For IgG, normal median values (and 95% ranges) in 108 sera were: IgGκ 6,981 mg/L (3,608–11,655); IgGλ 3,946 mg/L (2,023–9,158); IgGκ/IgGλ ratio 1.8 (1.15–2.70). Correlation of IgGκ+IgGλ vs total IgG, 0.8: p&lt;0.01 (Pearson’s rank test). For IgA in 191 normal sera, respective values were: IgAκ 1,270 mg/L (440–2,360); IgAλ 870 mg/L (340–1,850); IgAκ/IgAλ ratio 1.47 (0.58–2.52). Correlation of IgAκ+IgAλ vs total IgA, 0.924: p&lt;0.001. For IgG MM sera, sensitivity of the IgGκ/IgGλ ratios were compared to IFE. In all of 19 presentation sera and all samples during serial monitoring of 9 patients (4 IgGκ; 5 IgGλ), the appropriate immunoglobulin results were elevated and IgGκ/IgGλ ratios were abnormal indicating similar or greater sensitivity. In 3/9 patients during monitoring, IgGκ or IgGλ results were abnormal at complete remission (as judged by normal IFE results). Overall, relapse and responses were also detected earlier by IgGκ or IgGλ than by SPE or IFE. In addition, 2/9 patients showed discordant results with no change in IgGκ/IgGλ ratios during chemotherapy but a marked fall in total IgG measurements. For IgA MM presentation sera, all 83 had abnormal IgAκ/IgAλ ratios but 46 could not be quantified by SPE because of diffuse or overlapping protein bands. In 14 patients assessed during disease monitoring, all samples had IgAκ/IgAλ ratios that corresponded with IFE; in 5/14 patients, the results could not be quantified by SPE because IgA bands were masked by other proteins. Kaplan Meier survival curves on patients with ratios (either IgAκ/IgAλ or IgAλκ/IgAκ) greater than 500 (mean 449: range 4.96–3,675) had worse outcome than below 500 ratios; 23 vs 34 months (p&lt;0.05). Conclusion: Measurements of IgGκ, IgGλ, IgAκ and IgAλ and their ratios were clinically at least as sensitive as SPE and IFE, both at diagnosis and for identifying residual disease. Furthermore, they provided quantitative results compared with the non-quantitative IFE method. Initial results for IgAκ/IgAλ ratios indicate a prognostic value at disease presentation suggesting a better clinical utility than total IgA measurements. Furthermore, IgGκ/IgGλ and IgAκ/IgAλ ratios may provide improved assessment of tumor responsiveness during monitoring in a similar manner to FLC κ/λ ratios. This may be due, in part, to the ratios compensating for changes in blood and plasma volume and reduced expression of FcRn IgG recycling receptors, resulting from chemotherapy.

Cast Nephropathy in Plasma Cell Dyscrasias

2019 ◽  
pp. 347-358
Author(s):  
Sandhya Manohar ◽  
Nelson Leung
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Plasma Cell ◽  
Light Chain ◽  
Wide Spectrum ◽  
Kidney Injury ◽  
Cast Nephropathy ◽  
Clinical Presentations ◽  
History Of ◽  
Plasma Cell Dyscrasias

Plasma cell dyscrasias are associated with a wide spectrum of renal lesions and clinical presentations. The most common is cast nephropathy, which clinically presents as severe acute kidney injury. It is usually seen in patients with multiple myeloma. In fact, the recent criteria of the International Myeloma Working Group from 2014 consider renal failure by light chain cast nephropathy as a myeloma defining event. Renal failure is a major cause of early mortality in patients with multiple myeloma, being second only to infection. Early diagnosis and treatment of multiple myeloma is the key to better outcomes in these patients. This chapter reviews, among other topics, the history of the terminology, mechanism of light chain cast formation and the clinical picture, precipitating factors, pathology, treatment, therapy, and future outlook for cast nephropathy.

scholarly journals Kidney failure as an unusual initial presentation of biclonal gammopathy (IgD multiple myeloma associated with light chain disease): A case report

2015 ◽  
Vol 72 (2) ◽  
pp. 196-199
Author(s):  
Violeta Rabrenovic ◽  
Zoran Mijuskovic ◽  
Slobodan Marjanovic ◽  
Milorad Rabrenovic ◽  
Dragan Jovanovic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Case Report ◽  
Light Chain ◽  
Bone Biopsy ◽  
Autologous Bone Marrow Transplantation ◽  
Laboratory Analysis ◽  
Team Work ◽  
Light Chain Disease ◽  
Biclonal Gammopathy

Introduction. Immunoglobulin D (IgD) myeloma is a rare disease, about 2% of all myelomas, even rarer when accompanied with another multiple myeloma in biclonal gammopathy. We presented a case of biclonal gammopathy - associated manifestation of IgD myeloma and light chain disease in a patient who initially had renal failure. Case report. 37-year-old male approximately one month before hospitalization began to feel malaise and fatigue along with decreased urination. Laboratory analysis revealed azotemia. A dialysis catheter was placed and hemodialysis started. The patient was then admitted to our hospital for further tests and during admission, objective examination revealed pronounced paleness with hepatosplenomegaly and hypertension (170/95 mmHg). Laboratory analysis showed erythrocyte sedimentation rate 122 mm/h, expressed anemic syndrome (Hb 71 g/L) and renal failure dialysis rank: creatinine 1,408 ?mol/L, urea31.7 mmol/L. There was two M components in serum protein electrophoresis: IgD lambda and free light chain lambda. Proteinuria was nephrotic rank (5.4 g/24 h), whose electrophoresis revealed 2 M components - massive in ? 2 fraction of 71%; 7% in the discrete ? fraction, beta 2M /serum 110 mg/L, in urine 1.8 mg/L - extremely high; IgL kappa / lambda index 1 : 13 (reference value ratio 2 : 1). The findings pointed to double myeloma disease: IgD myeloma and Bence Jones lambda myeloma. Bone biopsy confirmed IgD myeloma lambda 100% infiltration medulla predominantly plasmablasts. The treatment continued with hemodialysis 3 times per week with chemotherapy protocol bortezomib, doxorubicin, dexamethasone. After 4 cycles of chemotherapy, there was a decrease of IgD, ? - light chains, reduction in proteinuria (1.03 g/24 h), so hemodialysis was reduced to once per week. Six months after treatment initiation the patient underwent autologous bone marrow transplantation. In a 2-year follow-up period double myeloma disease showed complete remission. Conclusion. The presented rare form of double myeloma disease with initial renal insufficiency underscores the importance of careful observation and team-work that can alter the course of this serious disease.

scholarly journals Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil

2005 ◽  
Vol 47 (6) ◽  
pp. 315-320 ◽  
Author(s):  
Elizabeth De Francesco Daher ◽  
Geraldo Bezerra da Silva Júnior ◽  
Marúsia Thomaz Ferreira ◽  
Fernando Antonio de Sousa Barros ◽  
Tiago Magalhães Gurgel ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Hemodynamic Instability ◽  
Human Rabies ◽  
Tubular Necrosis ◽  
Post Mortem Findings ◽  
Histopathologic Findings

A retrospective study was conducted in nine patients with rabies admitted to a hospital of Fortaleza, Brazil. Autopsy was performed in all cases. The ages ranged from three to 81 years and six were males. They all were bitten by dogs. The time between the accident and the hospital admission ranged from 20 to 120 days (mean 45 ± 34 days). The time until death ranged from one to nine days (mean 3.3 ± 5.5 days). The signs and symptoms presented were fever, hydrophobia, aerophobia, agitation, disorientation, dyspnea, sialorrhea, vomiting, oliguria, sore throat, pain and hypoesthesia in the site of the bite, headache, syncope, cough, hematemesis, mydriasis, hematuria, constipation, cervical pain and priapism. In three out of six patients, there was evidence of acute renal failure, defined as serum creatinine > 1.4 mg/dL. The post-mortem findings in the kidneys were mild to moderate glomerular congestion and mild to intense peritubular capillary congestion. Acute tubular necrosis was seen in only two cases. This study shows some evidence of renal involvement in rabies. Histopathologic findings are nonspecific, so hemodynamic instability, caused by autonomic dysfunction, hydrophobia and dehydration must be responsible for acute renal failure in rabies.

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