Enhanced adsorption dialysis on acute kidney injury in micromolecular myeloma

Abstract

Acute kidney  injury ( AKI) is one of the mean causes of morbidity and mortality in patients with multiple myeloma. Approximately ten per cent of patients with diagnosis of multiple myeloma is in need of dialysis owing to AKI from accumulation of monoclonal free light chains (FLC) both K and lambda.

In order to increasing their removal haemodialysis with protein-leaking dialyzers is necessary.

It is clear that the series of filters with Polimetilmethacrylate (PMMA BK-F) is particularly able to absorb the FLC. The absorption has the greatest efficacy in the first hours of the dialysis, whereas it is almost lacking in the second part of  dialysis, when the membrane is saturated.

The Enhanced adsorption dialysis (EAD), trough the use of a second dialyzer, PMMA BK-F and of a second haematic line, doubles the absorption capacity.

We describe the case of a 70 years old patient, that comes to our examination owing to AKI in anuria. The positive serum immunofixation through K chains and osteological lesions, marked by RX, at the backbone and at the braincase, arouse suspicions of micromolecular myeloma, so the patient underwent dialytic treatment in EAD with halving of FLC lambda values and a 33 per cent decrease, following recovery of diuresis and partial betterment of renal function parameters.

Key Words: Micromolecular Myeloma, free light chains, Enhanced Adsorbtion dialysis

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INTRODUZIONE

Il Mieloma Multiplo è una discrasia plasmacellulare che rappresenta circa il 10% di tutte le neoplasie ematologiche. Il mieloma micromolecolare è una variante di mieloma in cui le plasmacellule producono in eccesso solo una parte delle immunoglobuline, le catene leggere (FLCs). Il 50% dei pazienti  con mieloma presenta all’esordio insufficienza renale, che nel 10% dei casi richiede trattamento emodialitico (13). 

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