Evaluation of Light Chain Removal Rates in Blood Purification Therapy for Light Chain Cast Nephropathy

IF 3.2 Q1 UROLOGY & NEPHROLOGY

Kidney Medicine Pub Date : 2025-03-17 DOI:10.1016/j.xkme.2025.100993

Hisashi Kamido , Shigekazu Kurihara , Yuki Oba , Kaito Hirota , Kansei Suzuki , Masayuki Yamanouchi , Tatsuya Suwabe , Kei Kono , Kenichi Ohashi , Yoshifumi Ubara , Naoki Sawa

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Abstract

Acute kidney injury is a crucial prognostic factor for multiple myeloma. The most common cause is light chain cast nephropathy. The primary pathology of light chain-induced acute kidney injury involves obstruction of distal tubules due to the interaction of free light chains (FLCs) with Tamm-Horsfall protein produced there. Based on this pathology, chemotherapy is used to suppress the production of FLCs. Recently, combined blood purification therapies to remove existing FLCs have been used. However, the extent to which FLCs are removed by blood purification therapy remains unclear. We investigated the dialysis removal rates under various conditions and found that hemodialysis achieved 16% removal, plasma exchange 75%, and online hemodiafiltration varied from 20% to 31%. Although online hemodiafiltration is less effective than plasma exchange, it is a viable option that does not require albumin infusions or lead to infections. Despite hematologic remission, renal recovery was limited by a high number of casts, severe interstitial fibrosis and tubular atrophy, and the delay in treatment initiation.

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轻链铸型肾病血液净化治疗轻链去除率的评价

急性肾损伤是多发性骨髓瘤的一个重要预后因素。最常见的原因是轻链铸型肾病。轻链诱发急性肾损伤的主要病理机制是游离轻链（FLCs）与远端肾小管产生的Tamm-Horsfall蛋白相互作用导致远端肾小管阻塞。基于这种病理现象，化疗被用来抑制游离轻链的产生。最近，还采用了联合血液净化疗法来清除现有的 FLCs。然而，血液净化疗法清除FLC的程度仍不清楚。我们对不同条件下的透析清除率进行了调查，发现血液透析的清除率为16%，血浆置换为75%，而在线血液透析滤过的清除率从20%到31%不等。虽然在线血液透析滤过的效果不如血浆置换，但它是一种可行的选择，不需要输注白蛋白，也不会导致感染。尽管血液学症状有所缓解，但由于大量的石膏、严重的间质纤维化和肾小管萎缩以及治疗启动的延迟，肾脏的恢复受到了限制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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