Pasquali Sonia, Iannuzzella Francesco, Corradini Mattia, Mattei Silvia, Bovino Achiropita, Stefani Alfredo, Palladino Giuseppe, Caiazzo Marialuisa
Department of Internal Medicine, Nephrology and Dialysis Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
J Nephrol. 2015 Apr;28(2):251-4. doi: 10.1007/s40620-014-0130-8. Epub 2014 Aug 23.
In myeloma cast nephropathy, fast reduction of serum free light chain (FLC) levels correlates with renal recovery. Recently, extracorporeal treatments using filters with a high-molecular weight cut-off have been successfully used for FLC removal. However, using these new filters, high cost and elevated albumin leakage are common drawbacks. We studied a new and cheaper therapeutic approach with adsorbent resins to evaluate its efficacy.
We treated four patients, affected by dialysis-dependent acute kidney injury (AKI) due to biopsy proven de novo FLC myeloma cast nephropathy. Each patient underwent bortezomib chemotherapy and extracorporeal treatment with the supra-hemodiafiltration with endogenous reinfusion (HFR) technique (Supra-HFR, Bellco Mirandola, Modena, Italy). Supra-HFR is a kind of hemodiafiltration that utilizes separated convection, diffusion and adsorption. The sorbent cartridge has a high affinity for FLC (both κ and λ) but is able to re-infuse albumin, avoiding the need for albumin perfusions. Supra HFR treatments (4 h each) were carried out for eight consecutive days and then every other day.
All patients showed a significant reduction of serum FLC, whereas serum albumin concentration remained unchanged. Renal function recovered in three out of four patients.
FLC removal with adsorbent resins represents an effective therapeutic strategy that does not require replacement with albumin .
在骨髓瘤管型肾病中，血清游离轻链（FLC）水平的快速降低与肾功能恢复相关。最近，使用高分子截留滤器的体外治疗已成功用于清除FLC。然而，使用这些新型滤器时，高成本和白蛋白漏出增加是常见的缺点。我们研究了一种使用吸附树脂的新型且更便宜的治疗方法，以评估其疗效。
我们治疗了4例因活检证实为新发FLC骨髓瘤管型肾病而依赖透析的急性肾损伤（AKI）患者。每位患者均接受硼替佐米化疗，并采用内源性再输注血液滤过（HFR）技术进行体外治疗（超级HFR，Bellco公司，米兰多拉，摩德纳，意大利）。超级HFR是一种利用分离的对流、扩散和吸附的血液滤过方式。吸附柱对FLC（κ和λ）具有高亲和力，但能够再输注白蛋白，无需进行白蛋白灌注。连续8天每天进行4小时的超级HFR治疗，之后隔天进行。
所有患者的血清FLC均显著降低，而血清白蛋白浓度保持不变。4例患者中有3例肾功能恢复。
使用吸附树脂清除FLC是一种有效的治疗策略，无需白蛋白替代。
