A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR).

BACKGROUND: 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. METHODS: 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. RESULTS: All patients showed a significant reduction of serum FLC, whereas serum albumin concentration remained unchanged. Renal function recovered in three out of four patients. CONCLUSIONS: FLC removal with adsorbent resins represents an effective therapeutic strategy that does not require replacement with albumin .

[Kidney damage caused by treatment for hematological malignancies: from tumor lysis syndrome to post-transplant kidney failure]. / Terapie onco-ematologiche e danno renale: dalla sindrome da lisi tumorale alla nefropatia post-trapianto di midollo.

In the wide spectrum of therapies for hematological malignancies, hematopoietic stem cell transplantation, whether autologous or allogeneic, is a common procedure. In addition to other transplant-related organ toxicities, renal failure is a common complication following transplantation. This paper discusses the incidence, timing, etiologies, risk factors and prognosis of renal failure associated with three commonly used transplantation procedures: myeloablative autologous, myeloablative allogeneic, and non-myeloablative allogeneic transplantation. The epidemiology and prognosis of renal failure are different after these three procedures. Severe renal failure occurs with all three varieties, but the frequency increases from myeloablative autologous to non-myeloablative allogeneic to myeloablative allogeneic. In all three types of transplantation, the mortality is clearly associated with the severity of renal injury, and it is greater than 80% when dialysis is required. Strategies to improve renal failure following transplantation may have a beneficial impact on these patients. Reduction of acute renal failure will likely reduce the severity of non-renal organ dysfunction, the incidence and severity of chronic kidney disease, and the mortality.

Banco de osso: um método simplificado / Bone banks: a simplinfied method

Os autores relatam o emprego de enxerto ósseo homólogo congelado, sua aplicaçäo como um método seguro, eficiente e de baixo custo. Baseando-se em uma metodologia convencional dos bancos de ossos, os autores salientam a viabilidade dos mesmos em locais desprovidos de maiores recursos