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Submitted: 10 Oct 2020
Accepted: 20 Dec 2020
ePublished: 13 Jan 2021
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J Nephropharmacol. 2021;10(2): e20.
doi: 10.34172/npj.2021.20
  Abstract View: 32
  PDF Download: 6

Original

Supportive treatment for cast nephropathy in patients with multiple myeloma; a pilot study

Giovanni Cancarini 1,2 * ORCID logo, Vincenzo Terlizzi 3 ORCID logo, Anna Garatti 3 ORCID logo, Letizia Zeni 4,5 ORCID logo, Mattia Tonoli 3, Elena Pezzini 3, Francesca Boni 3, Stefano Possenti 1 ORCID logo, Battista Fabio Viola 1, Mario Gaggiotti 1 ORCID logo

1 Nephrology Operative Unit, ASST Spedali Civili Brescia, Brescia, Italy
2 Nephrology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
3 Postgraduate School in Nephrology, University of Brescia, Italy
4 University of Campania “Luigi Vanvitelli”, Naples, Italy
5 Fondazione Policlinico Universitario A. Gemelli IRCCS, Nephrology Operative Unit, Rome, Italy
*Corresponding author: Giovanni Cancarini, Email: gcancarini@alice.it

Abstract

Introduction: Cast nephropathy is a prevalent cause of acute kidney injury (AKI) in patients with myeloma.

Objectives: The aim of this study is to define the outcome of a standardized supportive therapy for cast nephropathy.

Patients and Methods: Retrospective analysis of the outcome of cast nephropathy in a University hospital for a period of five years. Data analysed; serum creatinine, estimated glomerular filtration rate (eGFR; mL/min/1.73 m2 BSA) and need for dialysis. Standardized therapy with the aim of preventing/removing tubular casts; fluid administration and mannitol to increase urine flow, sodium bicarbonate to alkalize the urine and low dose steroid to reduce peritubular inflammation. Statistical analysis: Student’s t-test or the Mann-Whitney test according to data distribution. A two-tailed P value <0.05 was considered statistically significant. Survival curve was drawn according to Kaplan and Meier.

Results: Twenty-seven cases were reviewed. Upon admission, mean serum creatinine was 7.1±4.9 mg/dL and mean eGFR 6±4 mL/min/1.73 m2 BSA; 30% of patients had oligo-anuria. Diagnosis of cast nephropathy was presumptive in 23 patients, and renal biopsy proven in four. Hemodialysis was required by 10 (37%) patients, two of whom continued dialysis after discharge. At discharge, serum creatinine was 3.7±2.5 mg/dL and eGFR 20±13 mL/min/1.73 m2 BSA (P=0.002), and after a median of 3.4 months, the values were 2.9±2.1 mg/dL and 35±32 mL/min/1.73 m2 BSA, respectively. Patient survival was 60% after 24 months.

Conclusion: Administration of fluid, mannitol, sodium bicarbonate and low-dose steroid may improve the outcome of cast nephropathy. Despite the fact that the study has many limitations, its findings could be the base for prospective controlled trials on cast nephropathy and could be useful in those countries where the expensive extracorporeal treatments are not available.

Keywords: Acute kidney injury, Cast nephropathy, Light chains, Mannitol, Monoclonal gammopathy of renal significance, Myeloma kidney

Implication for health policy/practice/research/medical education:

Many papers have studied the effects of chemotherapy, dialysis, or plasma exchange on the outcome of cast nephropathy, however, none has described or standardized the supportive care. Our data suggest a standardized supportive therapy aimed to be; 1) a basis on which to design prospective controlled trials on the effects of new chemotherapy or of light chain removal method in cast nephropathy, 2) a standardized supportive therapy for those countries where the expensive extracorporeal treatments are not available.

Please cite this paper as: Cancarini G, Terlizzi V, Garatti A, Zeni L, Tonoli M, Pezzini E, Boni F, Possenti S, Fabio Viola B, Gaggiotti M. Supportive treatment for cast nephropathy in patients with multiple myeloma; a pilot study. J Nephropharmacol. 2021;10(2):e20. DOI: 10.34172/npj.2021.20.

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