Myeloma light chain cast nephropathy, a review

Sathick, Insara Jaffer; Drosou, Maria Eleni; Leung, Nelson

doi:10.1007/s40620-018-0492-4

Cited by 45 publications

(43 citation statements)

References 118 publications

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“…Such a mechanism could hypothetically be analogous to cast nephropathies by myeloma or myoglobin release from crushed muscles. [39][40][41][42] Interestingly, tubular casts in CN are predominantly found in aquaporin 2-positive collecting ducts in CBDL mice. 13 This key finding was recently confirmed in kidney biopsies of patients with CN.…”

Section: Bile Acidsmentioning

confidence: 96%

Cholemic Nephropathy Reloaded

Fickert

Rosenkranz

2019

Semin Liver Dis

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Acute kidney injury (AKI) is a dreaded complication in patients with liver disease and jaundice, since it is associated with significant morbidity and mortality. Cholemic nephropathy (CN) is thought to represent a widely underestimated important cause of AKI in advanced liver diseases with jaundice. The umbrella term CN describes impaired renal function along with histomorphological changes consisting of intratubular cast formation and tubular epithelial cell injury directed primarily toward distal nephron segments. In cholestasis, biliary constituents may be excreted via the kidney and bilirubin or bile acids may trigger tubular injury and cast formation, but as we begin to understand the underlying pathophysiologic mechanisms, we become increasingly aware of the urgent need for clearly defined diagnostic criteria. In the following, we aim to summarize current knowledge of clinical and morphological characteristics of CN, discuss potential pathomechanisms, and raise key questions to stimulate evolution of a research strategy for CN.

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Section: Bile Acidsmentioning

confidence: 96%

Cholemic Nephropathy Reloaded

Fickert

Rosenkranz

2019

Semin Liver Dis

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“…Acute RF is mainly produced by the formation and subsequent obstruction and inflammation of the distal tubules by light chain casts. This condition is attributed to a high tumor load 30 . A limitation of this study (besides its retrospective nature) is that very few patients underwent kidney biopsy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of renal failure recovery in patients with newly diagnosed multiple mieloma

et al. 2019

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Background: Renal failure (RF) is a common complication in patients with newly diagnosed multiple myeloma (NDMM). Aim: To evaluate the frequency of RF in NDMM patients, and the prognostic impact of its reversibility. Material and Methods: A retrospective study evaluating demographic and clinical characteristics of 154 consecutive patients with NDMM was carried out. Estimated glomerular filtration rate (eGFR) was calculated at the beginning and at the end of the induction therapy. In addition, we evaluated renal responses (RR) according to the International Myeloma Working Group (IMWG) criteria. The induction regimen was based on thalidomide in all cases. Results: Fifty-three patients had RF (34.4%). Complete renal response (RR) was achieved in 51%. Three years overall survival in patients without RF, with RF and complete RR, and patients with RF and any other RR, was 66, 47 and 13%, respectively. Median survival was 53, 27 and 6 months, respectively (p < 0.01). In the multivariate analysis, RF and hypercalcemia were independent predictors of a worse outcome. Conclusions: Achieving a complete RR in patients with NDMM, is associated with a better survival. (Rev Med Chile 2019; 147: 1374-1381 Impacto pronóstico de remisión renal en pacientes con mieloma múltiple de reciente diagnóstico Antecedentes: La falla renal (FR) es una complicación frecuente en pacientes con mieloma múltiple (MM). Objetivo: Evaluar la frecuencia de FR en pacientes con reciente diagnóstico de MM y determinar la importancia pronóstica de su reversibilidad. Material y Métodos: Se realizó un estudio retrospectivo de 154 pacientes consecutivos con MM. La función renal se evaluó mediante la tasa estimada de filtración glomerular al inicio y final de la terapia de inducción. Además, evaluamos las respuestas renales (RR) de acuerdo con los criterios del International Myeloma Working Group (IMWG). El régimen de inducción se basó en talidomida en todos los casos. Resultados: Cincuenta y tres pacientes presentaron FR (34,4%) al diagnóstico. La RR completa se logró en 51%. La sobrevida global (SG) a 3 años en pacientes sin FR, con FR y RR completa, y

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“…Myeloma nephropathy is relatively common complications in patients with MM. Generally, the majority of severe renal injuries in patients with multiple myeloma are associated with immunoglobulin (Ig) free light chains (FLCs) [9,10]. Substantial FLCs (nephrotoxic proteins) accumulated in the proximal tubular epithelium are responsible for most tubulointerstitial injuries.…”

Section: The Relationship Between Cystatin C and Myeloma Nephropathymentioning

confidence: 99%

The role of cystatin C as a proteasome inhibitor in multiple myeloma

Jiang

Zhang

et al. 2020

Hematology

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Objectives: Bone destruction and renal impairment are two frequent complications of multiple myeloma (MM). Cystatin C, an extracellular cysteine proteinase inhibitor, is encoded by the housekeeping gene CST3 and associated with human tumors. The role of cystatin C in multiple myeloma has been revealed recently. The purpose of this study was to explore the role of cystatin C as a proteasome inhibitor in multiple myeloma. Methods: A comprehensive literature review was conducted through Pubmed to summarize the published evidence on cystatin C in multiple myeloma. English literature sources since 1999 were searched, using the terms cystatin C, multiple myeloma. Results: cystatin C is a sensitive indicator for the diagnosis of myeloma nephropathy and has a dual role in myeloma bone disease. Also, cystatin C reflects tumor burden and is strongly associated with prognosis in patients with multiple myeloma. Conclusion: Cystatin C have great diagnostic and prognostic value in multiple myeloma. It can provide a new treatment direction for MM by designing and searching for antagonists of cystatin C or cysteine protease agonists using cystatin C as a therapeutic target.

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Myeloma light chain cast nephropathy, a review

Cited by 45 publications

References 118 publications

Cholemic Nephropathy Reloaded

Cholemic Nephropathy Reloaded

Prognostic impact of renal failure recovery in patients with newly diagnosed multiple mieloma

The role of cystatin C as a proteasome inhibitor in multiple myeloma

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