title: Novel approaches for reducing free light chains in patients with myeloma kidney.
abstract: Myeloma kidney is a tubulointerstitial pathology that accounts for approximately 80-90% of severe acute kidney injury in patients with multiple myeloma. Unless there is rapid intervention, progressive irreversible damage from interstitial fibrosis and tubular atrophy occurs. Work over the past decade has demonstrated that an early sustained reduction in serum concentrations of pathogenic monoclonal free light chains (FLCs) leads to improved renal recovery rates. In turn, an early improvement in renal function is associated with improved patient survival. An early reduction in FLC levels should therefore become standard of care, although the optimum mechanisms to achieve this depletion of FLCs remain to be determined. To provide a coordinated, cross-disciplinary approach to research in this disease, the International Kidney and Monoclonal Gammopathy Research Group was formed. In this Review, we address the current state of knowledge in the management of myeloma kidney.
authors.affiliation: Renal Institute of Birmingham, University Hospital Birmingham and University of Birmingham, Birmingham, UK. c.a.hutchison@ bham.ac.uk
authors.forename: Colin A
authors.initials: CA
authors.lastname: Hutchison
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Mark
authors.initials: M
authors.lastname: Cook
authors.forename: Mark
authors.initials: M
authors.lastname: Drayson
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Fermand
authors.forename: Efstathios
authors.initials: E
authors.lastname: Kastritis
authors.forename: Robert
authors.initials: R
authors.lastname: Kyle
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.forename: Sonia
authors.initials: S
authors.lastname: Pasquali
authors.forename: Christopher
authors.initials: C
authors.lastname: Winearls
mesh_terms: D003907:Dexamethasone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000378:metabolism*; D007155:Immunologic Factors / Q000627:therapeutic use*; D009101:Multiple Myeloma / Q000150:complications* / Q000378:metabolism; D009395:Nephritis, Interstitial / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism
chemical_list: D005938:Glucocorticoids; D007147:Immunoglobulin Light Chains; D007155:Immunologic Factors; D003907:Dexamethasone