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.
- Cast nephropathy
Only the last is amenable to plasmapheresis. Whether it works has been the subject of three prospective randomized studies:
- Zucchelli 1988
- Johnson 1990
- 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.
Just saw a urine urea of 1,019 mg/dL. I can’t remember ever seeing one over 1,000 before. The FE Urea was 55% in a urosepsis induced AKI.
I was scheduled to give a talk on disorders of sodium and water to the fellows yesterday. We have a particularly clever cohort of fellows this year and I really couldn’t give them a warmed over version of my resident and student sodium lecture so I put together this talk which looks five different issues with hyponatremia and some data regarding them:
- mannitol induced pseudohyponatremia
- TURP syndrome
- uremia and propensity for myelinolysis
- exercise induced hyponatemia
- differentiation of salt delpetion from SIADH with FENa, FEUrea and FE Uric acid with a couple of slides on treating SIADH with saline
Remember, downloading the native Keynote file will give you animations and a better looking experience.