title: Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters.
abstract: BACKGROUND
  Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis.
  
  
  METHODS
  We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m(2) HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days.
  
  
  RESULTS
  A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session.
  
  
  CONCLUSIONS
  Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed.
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Berni Wennekers
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Martín Azara
authors.affiliation: Servicio de Hematología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Dourdil Sahun
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bergasa Liberal
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: José Esteban
authors.initials: JE
authors.lastname: Ruiz Laiglesia
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
authors.forename: Patricia
authors.initials: P
authors.lastname: Vernet Perna
authors.affiliation: Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España. Electronic address: ralvarezl@senefro.org.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alvarez Lipe
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology / Q000628:therapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007147:Immunoglobulin Light Chains / Q000032:analysis; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D008970:Molecular Weight; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D009194:Myeloma Proteins / Q000032:analysis; D006435:Renal Dialysis / Q000191:economics / Q000295:instrumentation*
chemical_list: D000970:Antineoplastic Agents; D007147:Immunoglobulin Light Chains; D008567:Membranes, Artificial; D009194:Myeloma Proteins
keywords: Dialysis with high cut off filters; Diálisis con filtros de high cut off; Insuficiencia renal aguda; Mieloma múltiple; Multiple myeloma; acute renal failure