title: A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR).
abstract: 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 .
authors.affiliation: Department of Internal Medicine, Nephrology and Dialysis Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pasquali
authors.forename: Francesco
authors.initials: F
authors.lastname: Iannuzzella
authors.forename: Mattia
authors.initials: M
authors.lastname: Corradini
authors.forename: Silvia
authors.initials: S
authors.lastname: Mattei
authors.forename: Achiropita
authors.initials: A
authors.lastname: Bovino
authors.forename: Alfredo
authors.initials: A
authors.lastname: Stefani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Palladino
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Caiazzo
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000069286:Bortezomib / Q000627:therapeutic use; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D000970:Antineoplastic Agents; D007147:Immunoglobulin Light Chains; D012709:Serum Albumin; D000069286:Bortezomib