Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 22 (6), 1129-1136
- https://doi.org/10.1681/asn.2010080857
Abstract
Myeloma kidney is the major cause of severe irreversible renal failure in patients with multiple myeloma. This tubulointerstitial injury is a direct consequence of high concentrations of circulating monoclonal free light chains (FLCs) produced by a clonal expansion of plasma cells. Early reduction of serum FLCs associates with renal recovery, but the target threshold of reduction to facilitate renal recovery is unknown. To determine the relationship between the achieved FLC reduction and renal recovery, we identified 39 patients with biopsy-proven myeloma kidney, the majority of whom had severe renal failure at presentation (median estimated GFR 9 ml/min per 1.73 m2). In a multivariable analysis incorporating demographic, hematologic, and renal variables, only the achieved FLC reduction significantly predicted renal recovery (P = 0.003). The relationship between renal recovery and FLC reduction was linear with no absolute threshold for FLC reduction. A 60% reduction in FLCs by day 21 associated with recovery of renal function for 80% of the population. Patient survival strongly associated with renal recovery: the median survival was 42.7 months (range 0 to 80) among those who recovered function compared with 7.8 months (range 0 to 54) among those who did not (P < 0.02). Cox-regression analysis demonstrated that the first presentation of myeloma, the kappa isotype of FLC, and renal recovery were independent predictors of survival. In conclusion, recovery of renal function in myeloma kidney depends on early reduction of serum FLCs, and this recovery associates with a significant survival advantage.Keywords
This publication has 36 references indexed in Scilit:
- The Incidence of Major Hemorrhagic Complications After Renal Biopsies in Patients with Monoclonal GammopathiesClinical Journal of the American Society of Nephrology, 2010
- Light Chain–Induced Acute Renal Failure Can Be Reversed by Bortezomib-Doxorubicin-Dexamethasone in Multiple Myeloma: Results of a Phase II StudyJournal of Clinical Oncology, 2010
- Proteasome inhibitors in the treatment of multiple myelomaLeukemia, 2009
- Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Chemotherapy and Extended High Cut-Off HemodialysisClinical Journal of the American Society of Nephrology, 2009
- Quantitative Assessment of Serum and Urinary Polyclonal Free Light Chains in Patients with Chronic Kidney DiseaseClinical Journal of the American Society of Nephrology, 2008
- European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): A randomised control trialTrials, 2008
- Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failureBMC Nephrology, 2008
- Efficient Removal of Immunoglobulin Free Light Chains by Hemodialysis for Multiple MyelomaJournal of the American Society of Nephrology, 2007
- Activity and safety of bortezomib in multiple myeloma patients with advanced renal failure: a multicenter retrospective studyBlood, 2006
- International uniform response criteria for multiple myelomaLeukemia, 2006