Abstract
Cast nephropathy is the main cause of renal impairment in patients with multiple myeloma (MM). Serum free light chain (sFLC) removal by extended hemodialysis on a protein leaking membrane may aid renal recovery. A patient presenting with MM, high serum FLC concentrations and dialysis dependent acute renal failure was studied. A renal biopsy showed monoclonal kappa FLC cast nephropathy. He was dialysed for 2–8h on daily / alternate days using the Gambro HCO 1100 dialyser. sFLC were measured at frequent intervals in the serum and dialysate fluids. Albumin and urea concentrations were measure pre- and post-dialysis. Over 22 days the patient underwent 14 dialysis sessions with an average sFLC reduction of 38% (15.2–61.8%). A total of 16.5g of kappa was removed in the dialysate fluid with an average concentration of 18.3mg/L (3.3–27.3). Figure 1 demonstrates serum reductions in kappa concentrations pre- and post-dialysis and timing of chemotherapy. The average serum reductions were: albumin 2.1g/L, urea 56% and creatinine 44%. By day 22 the patient was independent of dialysis. Four months later renal function is stable with an eGFR of 35ml/min (Cockcroft-Gault). Further studies are needed to determine whether this method would benefit many patients with acute renal failure and light chain cast nephropathy.
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Disclosures: Arthur Bradwell is Chairman of The Binding Site Ltd.; Arthur Bradwell is a major shreholder in The Binding Site Ltd.
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