Evaluation of Blood Purification and Bortezomib Plus Dexamethasone Therapy for the Treatment of Acute Renal Failure Due to Myeloma Cast Nephropathy
Evaluation of Blood Purification and Bortezomib Plus Dexamethasone Therapy for the Treatment of Acute Renal Failure Due to Myeloma Cast Nephropathy
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DOI：
10.1111/j.1744-9987.2010.00863.x
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发表时间：
2010-10-01
影响因子：
1.9
通讯作者：
Yuzawa, Yukio
中科院分区：
文献类型：
--
作者：
Hasegawa, Midori;Kondo, Fumiko;Yuzawa, Yukio
通过血液净化结合化疗积极清除循环游离轻链（FLC）是治疗骨髓瘤管型肾病所致急性肾衰竭的一种有前景的方法。已进行血浆置换以清除血清FLC;为了检查替代策略，我们使用蛋白质泄漏透析器进行血液透析滤过，以治疗骨髓瘤管型肾病引起的透析依赖性急性肾衰竭。在第一例κ轻链管型肾病中，治疗前血清肌酐为9.65 mg/dL，血清kappa-FLC为27 100 mg/L。在前几周的周一至周五进行血浆置换或血液透析滤过。化疗开始时使用大剂量地塞米松，然后改用硼替佐米加地塞米松。通过血浆置换，kappa-FLC的平均清除率为45.8%（1个血浆体积）和66.9%（1.5个血浆体积）。血液透析滤过的kappa-FLC清除率（66.9%，FB 210 UH β; 71.6%，PES 210 D α; 75.2%，FXS 220）与血浆置换相当。在第二例轻链管型肾病中，治疗前血清肌酐为4.14 mg/dL，血清FLC为4140 mg/L。血液透析滤过对FLC的平均清除率分别为60.2%（FXS 140）和64.2%（FB 210 UH β）。两例病例均不依赖透析。强化血液净化方案和硼替佐米加地塞米松治疗的组合似乎是肾脏恢复的有效方法。使用蛋白质泄漏透析器的血液透析滤过可能成为血浆置换的替代方法，作为清除FLC的方法。
Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with kappa-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum kappa-FLC was 27 100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of kappa-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of kappa-FLC by hemodiafiltration (66.9%, FB210UH beta; 71.6%, PES210D alpha; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with lambda-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum lambda-FLC was 4140 mg/L. The mean removal rates of lambda-FLC were 60.2% (FXS140) and 64.2% (FB210UH beta) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.