title: Recovery of kidney function following delayed use of Theralite™ dialyzer in a patient with myeloma cast nephropathy.
abstract: We report the case of a 60- year- old man who presented with newly diagnosed multiple myeloma complicated by biopsy-proven acute cast nephropathy, requiring hemodialysis, plasmapheresis and chemotherapy. After remaining dialysis dependent for 5 weeks, a high cut-off (HCO) dialyzer, intended to use for the removal of plasma substances with a molecular weight of up to 45 kDa such as free light chains, was introduced to his outpatient 4-hour hemodialysis regimen with an increase in treatment frequency to 4 sessions per week. Following 6 weeks of dialysis with the HCO dialyzer, serum levels of free κ light chains declined by more than 75%. Concurrently, he recovered kidney function and discontinued dialysis. He subsequently received a successful autologous stem-cell transplant. We discuss the potential merit of using the HCO dialyzer late in the course of the care of patients with myeloma cast nephropathy who are dialysis dependent.
authors.affiliation: Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
authors.forename: Khagendra
authors.initials: K
authors.lastname: Dahal
authors.forename: Shani
authors.initials: S
authors.lastname: Shastri
authors.forename: Uma
authors.initials: U
authors.lastname: Narayanasami
authors.forename: Vanesa
authors.initials: V
authors.lastname: Bijol
authors.forename: Karen
authors.initials: K
authors.lastname: Rider
authors.forename: James A
authors.initials: JA
authors.lastname: Strom
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D004867:Equipment Design; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000097:blood; D007668:Kidney / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D010956:Plasmapheresis; D020127:Recovery of Function; D006435:Renal Dialysis / Q000295:instrumentation*; D033581:Stem Cell Transplantation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007145:Immunoglobulin kappa-Chains