Daidola Germana, Guarena Cesare, Brustia Maddalena, Leonardi Gianluca, Vigotti Federica N, Marciello Antonio, Bianco Simona, Chiarinotti Doriana, Saltarelli Marco, Besso Luca, Biancone Luigi
S.C. Nefrologia e Dialisi AO S. Croce e Carle di Cuneo, Cuneo, Italia.
S.C. Nefrologia, Dialisi e Trapianto U. AOU Città della Salute e della Scienza di Torino, Torino, Italia.
G Ital Nefrol. 2018 Dec;35(6).
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.
急性肾损伤（AKI）是多发性骨髓瘤（MM）常见的并发症，具有不良预后意义。清除轻链并联合血液学治疗（CT）似乎对肾功能恢复（RFR）有显著益处。SUPRA HFR通过结合无白蛋白丢失的高截留膜和吸附柱，是“新兴”的轻链清除方法之一。我们报告了7例MM患者接受SUPRA HFR治疗的多中心回顾性经验。在SUPRA HFR治疗结束时，观察到血清游离轻链较基线显著降低（最低24%；最高90%；中位数74%）。尽管治疗并非总是尽早开始，但所有患者均恢复了肾功能，7例中有6例停止了透析。我们对7例AKI-MM患者采用SUPRA HFR治疗联合CT的初步经验显示，肾功能有显著恢复，成本效益比良好，治疗方案简单。这些令人鼓舞的数据表明应进一步扩大这种治疗选择，同时等待该领域的更大规模研究。
