Renal impairment in monoclonal gammopathies and multiple myeloma
Authors:
Romana Ryšavá
Authors place of work:
Klinika nefrologie 1. LF UK a VFN v Praze
Published in the journal:
Čas. Lék. čes. 2024; 163: 98-105
Category:
Review Article
Summary
The incidence of monoclonal gammopathy (MG) increases with age. In individuals over 80 years of age, we can diagnose the presence of monoclonal immunoglobulin (MIg) in up to 10 % of cases. Not only malignant diseases such as multiple myeloma (MM), but also benign forms such as MGUS (monoclonal gammopathy of undetermined significance) can lead to renal involvement. The light chains of immunoglobulins (LC) are the most damaging to the kidneys, as they are freely filtered into the urine due to their molecular weight.
Detection of MIg relies mainly on a combination of immunofixation electrophoresis of serum (IELFO) and urine and determination of free light chains (FLC) of kappa and lambda and their ratio (κ/λ) in serum. The combination of these tests will detect the presence of MIg with 99 % sensitivity. Renal damage in MG may be caused by direct deposition of MIg in the glomeruli (e.g. AL amyloidosis, LC deposition disease) or tubules (in the distal tubule as a myeloma kidney or in the proximal tubule as Fanconi syndrome or proximal tubulopathy). Typical urinary findings in these diseases are moderate or severe proteinuria or nephrotic syndrome. Acute kidney injury (AKI) can be expected especially when serum FLC is >500 mg/l. Renal biopsy is crucial to establish an accurate diagnosis and thus initiate the correct treatment. Treatment of these types of renal damage involves the same treatment regimens used in the treatment of MM, including proteasome inhibitors or daratumumab.
Keywords:
monoclonal immunoglobulin, MGUS. multiple myeloma, AL amyloidosis, acute kidney injury, chronic kidney injury
Zdroje
- Bridoux F, Leung N, Hutchison C et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int 2015; 87: 698–711.
- Wochner RD, Strober W, Waldmann TA. The role of the kidney in the catabolism of Bence Jones proteins and immunoglobulins fragments. J Exp Med 1967; 126: 207–221.
- Ying WZ, Wang PX, Sanders PW. Pivotal role of apoptosis signal-regulating kinase 1 in monoclonal free light chain-mediated apoptosis. Am J Patol 2012; 180: 41–47.
- Tsakiris DJ, Stel VS, Finne P et al. Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposition disease: an ERA-EDTA Registry study. Nephrol Dial Transplant 2010; 25: 1200–1206.
- Knudsen LM, Hippe E, Hjorth M et al. Renal function in newly diagnosed multiple myeloma – a demographic study of 1353 patients. The Nordic Myeloma Study Group. Eur J Haematol 1994; 53: 207–212.
- Dimopoulos MA, Merlini G, Bridoux F et al. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24: e293–311.
- Dimopoulos MA, Sonneveld P, Leung N et al. International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment. J Clin Oncol 2016; 34: 1544–1557.
- Dimopoulos MA, Terpos E, Chanan-Khan A et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol 2010; 28: 4976–4984.
- Wirk B. Renal failure in multiple myeloma: a medical emergency. Bone Marrow Transplant 2011; 46: 771–783.
- Korbet SM, Schwartz MM. Multiple myeloma. J Am Soc Nephrol 2006; 17: 2533–2545
- Heher EC, Rennke HG, Laubach JP, Richardson PG. Kidney disease and multiple myeloma. Clin J Am Soc Nephrol 2013; 8: 2007–2017.
- Sengul S, Zwizinski C, Batuman V. Role of MAPK pathways in the light chain induced cytokine production in human proximal tubule cells. Am J Renal Physiol 2003; 284: F1245–F1254.
- Cockwell P, Hutchison CA. Management options for cast nephropathy in multiple myeloma. Curr Opin Nephrol Hypertens 2010; 19: 550–555.
- Herrera GA, Sanders PW. Paraproteinemic renal diseases that involve the tubulo-interstitium. Contrib Nephrol 2007; 153: 105–115.
- Royal V, Leung N, Troyanov S et al. Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study. Blood 2020; 135: 1833–1846.
- Ryšavá R. AL amyloidosis with renal involvement. Kidney Blood Pres Res 2007; 30: 359–364
- Zhu L, Herrera GA, Murphy-Ullrich JE et al. Pathogenesis of glomerulosclerosis in light chain deposition disease. Role for transforming growth factor-beta. Am J Pathol 1995; 147: 375–385.
- Hutchison CA, Basnayake K, Cockwell P. Serum free light chain assessment in monoclonal gammapathy and kidney disease. Nat Rev Nephrol 2009; 5: 621–627.
- Bradwell AR, Harding SJ, Fourrier NJ et al. Assessment of monoclonal gammapathies by nephelometric measurement of individual immunoglobulin kappa/lambda ratios. Clin Chem 2009; 55: 1646–1655.
- Hutchison CA, Plant T, Drayson M. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrology 2008; 9: 11–19.
- Dispenzieri A, Kyle R, Merlini G et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009; 23: 215–224.
- Ludwig H, Drach J, Graf H et al. Reversal of acute renal failure by bortezomib-based chemotherapy in patients with multiple myeloma. Haematologica 2007; 92: 1411–1414.
- Kastritis E, Anagnostopoulos ARoussou M et al. Reversibility of renal failure in newly diagnosed multiple myeloma patiens treated with high dose dexamethazone-containing regimes and tje impact of novel agents. Haematologica 2007; 92: 546–549.
- Adam Z, Štepánková S, Zeman D et al. Léčba poškození ledvin monoklonálním imunoglobulinem a volnými lehkými řetězci. Acta Medicinae 2023; 12-13: 3–13.
- Clark WF, Stewart AK, Rock GA et al. Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 2005; 143: 777–784.
- Bridoux F, Carron PL, Pegourie B et al. Effect of high-cutoff hemodialysis vs conventional hemodialysis on hemodialysis independence among patients with myeloma cast nephropathy. A randomized clinical trial. JAMA 2017; 318: 2099–2110.
- Hutchison CA, Cockwell P, Moroz V et al. High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): a phase 2 randomised controlled trial Lancet Haematol 2019; 6: e217–e228.
- Wechalekar D, Cibeira MT, Gibbs SD et al. Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working group. Amyloid 2023; 30: 3–17.
- Pika T, Hájek R, Flodr P et al. Diagnostika a léčba systémové AL amyloidózy. Transfuze a hematologie dnes 2022; 28 (Suppl. 1): 6–40.
- Kastritis E, Palladini G, Minnema MC et al. Daratumumab-based treatment for immunoglobulin light-chain amyloidosis. N Engl J Med 2021; 385: 46–58.
- Finkel K, Fabbrini P. High cut-off hemodialysis for myeloma cast nephropathy – do we finally have an answer? J Onco-Nephrol 2017; 1: 67–70.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
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