Efficacy of SUPRA HFR in the treatment of acute renal damage during multiple myeloma

Abstract

Acute Kidney Injury (AKI) is a frequent complication of multiple myeloma (MM) with unfavorable prognostic significance.

Light chains removal, combined with hematological therapy (CT) seems to offer significant benefits to renal function recovery (RFR).

The SUPRA HFR, through the combination of high cut-off membrane without albumin loss and adsorbent cartridge, represents one of the “emerging” light chain removal methods. We report our multicentric retrospective experience with SUPRA HFR in 7 MM patients.

At the end of the treatment with SUPRA HFR a significant reduction in serum free light chains compared to baseline was observed (min 24%; max 90%; median 74%). Despite a not always early start of the treatment, all patients recovered renal function with withdrawal from dialysis in 6/7 cases.

Our preliminary experience of a combination of SUPRA HFR treatment with CT in 7 MM patients with AKI showed a significative renale functional recovery, with favourable cost/benefit ratio and a simple treatment schedule. These encouraging data suggest to further extend such treatment option, waiting for larger studies in this field.

 

Keywords:

Acute Kidney Injury, haemodiafiltration, multiple myeloma

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Introduzione

Il coinvolgimento renale è una complicanza frequente del mieloma multiplo (40-50% dei casi) e può essere di entità estremamente variabile sino a richiedere il trattamento dialitico sostitutivo in circa l’8-10% dei casi (1, 2).  

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Severe lactic acidosis requiring continuos haemodiafiltration in a young patient with unrecognized metabolic abnormality. Case report

Abstract

Background: Lactic acidosis (LA) is the most common form of metabolic acidosis, defined by lactate values greater than 5 mmol/L and pH<7.34. The pathogenesis of LA involves hypoxic causes (type A) and non-hypoxic (type B), often coexisting. Identification and removal of the trigger are mandatory in the therapeutic management of LA. The case: A 38 years-old male patient entered the Emergency Ward for dyspnea, fever, vomiting and hyporexia. An important respiratory distress with hyperventilation due to severe LA was found, together with severe hypoglicemia, without renal impairment. Past medical history unremarkable, except for reported episodic hypoglicemia in the childhood, with fructose “intolerance”, without any other data. No evidence of intoxications, septic shock or significant cytolysis. No drugs causing LA.

The patient underwent orotracheal intubation, glucose infusion, and continuous haemodiafiltration for 36-hrs. A rapid general improvement was obtained with stabilization of acid-base balance.

A diagnosis of fructose-1,6-diphosphatase deficiency was made. It is an autosomical recessive gluconeogenesis abnormality, with recurrent episodes of hypoglicemia and lactic acidosis after fasting, potentially lethal.

The therapy is based on avoiding prolonged fasts, glucose infusion, and a specific diet, rich in glucose without fructose intake.

Conclusions: The presence of not-otherwise-explained lactic acidosis in young patients has to place the suspect of an underlying and unknown metabolic derangement; in these cases, the involvement of the nephrologist appears to be pivotal for the differential diagnosis of the abnormalities of the acid-base balance, and for setting the best treatment.

 

Keywords: lactic acidosis, gluconeogenesis abnormalities, haemodiafiltration.

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Introduzione

L’acidosi lattica è la risultanza di un’eccessiva produzione di lattato (da parte di tessuti con attività glicolitica) e/o di una sua ridotta utilizzazione (da parte di tessuti con attività gluconeogenetica).

Essa viene classicamente distinta in due categorie:

Tipo A – caratterizzata da una iperproduzione di lattato in condizioni di ipossia tissutale (attività muscolare anaerobia, ipoperfusione tessutale, stati di shock, ridotta disponibilità, rilascio o utilizzazione di ossigeno) 

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