Valoración del flujo de la fístula arteriovenosa en pacientes en tratamiento con quelantes con calcio / Evaluation of arteriovenous fistula blood flow in patients with calcium chelation therapy

No disponible

Tratamiento con hemodiálisis larga con filtros de alto cut-off en la nefropatía por cilindros del mieloma: nuestra experiencia / Treatment by long haemodialysis sessions with high cut-off filters in myeloma cast nephropathy: our experience

El mieloma múltiple (MM) consiste en la proliferación incontrolada de células plasmáticas con producción de cantidades variables de inmunoglobulinas o sus cadenas. La insuficiencia renal aguda puede ser un síntoma del MM, y a veces su forma de presentación. Las cadenas ligeras libres circulantes (CLL) pueden dar lugar al fallo renal por la precipitación intratubular de ellas, causando una nefropatía por cilindros. El tratamiento del mieloma, una adecuada hidratación y la eliminación de CLL mediante técnicas de aféresis son los tratamientos admitidos actualmente para esta entidad. Se han intentado diversas técnicas de aféresis para intentar eliminar las CLL, siendo la hemodiálisis de larga duración con filtros para eliminar dichas cadenas ligeras (alto cut-off) la que se postula como el tratamiento más eficaz para la nefropatía del mieloma. MÉTODOS: Presentamos cinco casos de nefropatía de mieloma: tres con nefropatía por cilindros (NC) diagnosticada por biopsia renal y dos con alta probabilidad de NC (niveles de CLL > 500 mg/l) tratados con hemodiálisis larga con membrana de alto cut-off. Todos presentaban insuficiencia renal aguda, en cuatro de ellos con necesidad de terapia sustitutiva y uno en situación de insuficiencia renal avanzada. En todos ellos los niveles de CLL fueron muy elevados. Recibieron tratamiento específico para el mieloma más hemodiálisis de alto cut-off hasta alcanzar niveles de CLL < 500 mg/l. RESULTADOS: Cuatro de los cinco pacientes recuperaron función renal, quedando independientes de diálisis. El tiempo de evolución del mieloma desde el inicio de la clínica fue variable (1-6 m). El número de sesiones varió entre 8-16. El paciente de más tiempo de evolución precisó más sesiones y no recuperó función renal. CONCLUSIONES: La hemodiálisis larga con filtros de alto cut-off más tratamiento con quimioterapia del mieloma parece ser un tratamiento eficaz en la insuficiencia renal aguda debida a nefropatía del mieloma. La precocidad en el inicio del tratamiento puede ser un factor determinante de la respuesta

Multiple myeloma (MM) is the uncontrolled proliferation of plasma cells with variable amounts of production of immunoglobulin or their chains. Acute renal failure can be a symptom of MM, and it is sometimes their presentation form. Circulating free light chains (FLC) could led to renal failure by intratubular precipitation of themselves causing a cast nephropathy. Myeloma's treatment, an adequate hydration and FLC's elimination by aphaeresis treatments are currently eligible therapy for this entity. Several aphaeresis techniques have been tried to eliminate the FLC being long-term hemodialysis with filters to remove these light chains (High Cut-Off filters). This treatment is postulated as the most effective treatment for myeloma nephropathy. METHODS: We report 5 cases of myeloma nephropathy: three of them with cast nephropathy (CN) diagnosed by renal biopsy and another two with high probability of NC (FLC levels >500mg/L). All of them were treated by hemodialysis with membrane high Cut-Off. The five patients had had an acute renal failure; in four of them need replacement renal therapy. The fifth patient only had an advanced renal failure. In all patients, FLC levels were very high. All patients received specific treatment for myeloma in addiction on hemodialysis high Cut-Off until the FLC levels were <500mg/ L. RESULTS: Four of the five patients recovered renal function, being independent of dialysis. The evolution time of myeloma since the first symptoms appeared was variable (1-6 months). The number of treatment sessions ranged from 8-16. The patient whose evolution time was the longest one required more sessions and did not recovered the renal function. CONCLUSIONS: Length hemodialysis with filters high cut-off plus specific myeloma chemotherapy seems to be an effective treatment in acute renal failure due to cast myeloma. The early initiation of treatment could be an important factor for the response

Treatment by long haemodialysis sessions with high cut-off filters in myeloma cast nephropathy: our experience.

UNLABELLED: Multiple myeloma (MM) is the uncontrolled proliferation of plasma cells with variable amounts of production of immunoglobulins or their chains. Acute renal failure can be a symptom of MM, and it is sometimes its form of presentation. Circulating free light chains (FLC) could lead to renal failure due to their intratubular precipitation, causing a cast nephropathy. The treatment of myeloma, adequate hydration and the removal of FLC by apheresis techniques are currently the treatments that are accepted for this disease. Several apheresis techniques have been attempted for the removal of FLC, with long haemodialysis sessions with filters for the removal of these light chains (high cut-off filters) being proposed as the most effective treatment for myeloma nephropathy. METHODS: We report 5 cases of myeloma nephropathy: three had cast nephropathy (CN) diagnosed by renal biopsy and the other two had a high probability of CN (FLC levels >500 mg/l). They were treated with long haemodialysis sessions with a high cut-off membrane. All patients had suffered acute renal failure; four required renal replacement therapy and one patient had advanced renal failure. In all patients, FLC levels were very high. They received specific treatment for myeloma in addition to high cut-off haemodialysis until they achieved FLC levels of <500 mg/l. RESULTS: Four of the five patients recovered renal function, and became independent of dialysis. The progression time for myeloma from the time the first symptoms appeared varied (1-6 months). The number of treatment sessions ranged from 8-16. The patient with the longest progression time required more sessions and did not recover renal function. CONCLUSIONS: Long haemodialysis sessions with high cut-off filters in addition to specific myeloma chemotherapy seems to be an effective treatment for acute renal failure due to myeloma nephropathy. The early initiation of treatment could be a determining factor for the response.