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.
Background: This study compared everolimus and mycophenolate mofetil, each paired with calcineurin inhibitors (CNIs) and used with or without steroids, for maintaining immunosuppression in kidney transplant (KT) patients. Methods: Relevant studies published before August 21, 2022 were retrieved from PubMed, the Cochrane Central Register of Controlled Trials, and the gray literature. The risk of bias was assessed independently using the revised Cochrane risk of bias assessment tool (RoB 2). RevMan ver. 5.4 was used to calculate the risk ratios (RRs) with corresponding 95% confidence intervals (CIs) for biopsy-proven acute rejection, death, and infection. The mean difference (MD) was used to compare the estimated glomerular filtration rate (eGFR) between the groups. Results: Sixteen randomized controlled trials with a total of 5,403 patients were synthesized to compare everolimus (n=2,763) with mycophenolate (n=2,542) for maintaining post-KT immunosuppression. The meta-analysis showed no significant difference in the risk for biopsy-proven acute rejection (RR=1.12; 95% CI, 0.92-1.35; I 2 =29%) and death (RR=0.85; 95% CI, 0.63-1.16; I 2 =0%). The eGFR had no significant difference between the two groups (MD=0.93; 95% CI, −2.25 to 4.1; I 2 =84%). The risk for any infection was significantly higher in the mycophenolate group than in the everolimus group (RR=0.83; 95% CI, 0.73−0.93; I 2 =66%). Conclusions: Our meta-analysis showed that when paired with a CNI, everolimus and mycophenolate had no difference in risk for biopsy-proven acute rejection, death, or increase in eGFR. However, the mycophenolate group exhibited a significantly higher risk of infection.
Background:The ideal immunosuppression for kidney transplant patients has the least incidence of acute rejection with the least occurrence of adverse events. This study aims to compare the everolimus against mycophenolate mofetil/sodium in combination with calcineurin inhibitors (CNI) with or without steroids as maintenance immunosuppression in kidney transplant patients. Methods: Studies, databases and literature were searched in Pubmed, the Cochrane Central Register of Controlled Trials and grey literature to identify relevant studies until August 21, 2022. Assessment of risk of bias was done independently by two authors using the revised Cochrane risk of bias assessment tool (RoB 2). Rev-man 5.4 program was used to calculate the risk ratio with corresponding 95% confidence interval for biopsy-proven acute rejection, death and infection. Mean difference was used to compare estimated glomerular filtration rate between two groups. Results: Sixteen RCTs with a total of 5,403 patients comparing everolimus (n=2,763) with MMF (n=2,542) in maintenance immunosuppression post kidney transplant were retrieved and synthesized in the meta-analysis. Results of the study showed no significant difference in the risk for biopsy-proven acute rejection (risk ratio [RR], 1.12; 95% confidence interval [CI], 0.92-1.35; P= 0.13; I2=29%) and death (RR, 0.85; 95% CI, 0.63-1.16; P= 0.57; I2=0%). There is no significant mean difference of the eGFR between two groups (mean deviation [MD], 0.93; 95% CI, -2.25-4.1; P<0.00001; I2= 84%). There was significant increased risks for any infection in the MMF group compared with the everolimus group (RR, 0.83; 95% CI, 0.73-0.93; P=0.0003; I2=66%). Conclusions: This meta-analysis showed that everolimus and MMF combined with CNI (cyclosporine or tacrolimus) have no difference in the risks for biopsy-proven acute rejection, death and increased in estimated GFR However, the MMF group exhibited a significant increased risks for any infection. They are equally safe and effective for kidney transplantation recipients.
The presence of posterior MAC, which is cheap and easy to detect with echocardiography, can predict all causes of death and cardiovascular death. This findings may further help risk stratification of maintenance hemodialysis patients in any dialysis center, including small dialysis center with limited medical resources, such as developing countries.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.