Monday, December 7, 2009

Cast Nephropathy and plasmapheresis

Does removal of the light chains with plasmapharesis reduce the severity of cast nephropathy? We know that renal failure is a terrible prognostic factor in multiple myeloma so fixing acute renal failure is important.

Renal failure comes in many different flavors with myeloma:
  • Light chain deposition disease
  • Heavy chain deposition disease that I have never seen but Steve Rankin had a case as a fellow.
  • Amylloidosis
  • Hypercalcemia
  • Cast nephropathy
Only the last is amenable to plasmapheresis. Whether it works has been the subject of three prospective randomized studies:
  1. Zucchelli 1988
  2. Johnson 1990
  3. Clark  2005 (PDF)

Though not randomized this recent article from KI should be of interest (Thanks Kyste):

Leung et al. Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains. Kidney Int (2008) vol. 73 (11) pp. 1282-8.
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