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Rapid improvement in renal function in patients with multiple myeloma and renal failure treated with bortezomib  [cached]
Qayum Abdul,Aleem Aamer,Al Diab Abdel,Niaz Faraz
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Multiple Myeloma (MM) frequently presents with renal dysfunction apart from other manifestations. Development of renal failure in patients with MM carries a poor prognosis. Bortezo-mib is a new addition to drugs used in MM and has shown good efficacy and safety profiles. Previous trials have shown its efficacy in relapsed and refractory MM as well. Studies have also shown that bortezomib is also effective in patients with MM who present with renal failure. We report here six cases of renal failure secondary to MM treated with bortezomib. All patients had poor performance status of 3-4 on ECOG scale. Five out of six patients showed satisfactory anti-myeloma response to bortezomib. Reversal of renal failure was observed in all six patients. Adverse effects to bortezomib were mild and manageable. Reversal of renal failure persisted despite incomplete response to MM in two cases, and progression of disease in one patient. It appears that bortezomib may have an effect on the kidneys in reversal of renal failure, other than its anti-myeloma effect. In conclusion, borte-zomib appears to be an effective treatment for patients with advanced MM and renal failure irres-pective of performance status and age.
Renal Failure in Multiple Myeloma "The Myeloma Kidney":State of the Art  [cached]
Goldschmidt Hartmut,Lannert Heinrich,Bommer Jurgen,Ho Anthony
Saudi Journal of Kidney Diseases and Transplantation , 2001,
Abstract: Renal failure is present in about 20% of patients with multiple myeloma (MM) at diagnosis. Renal function impairment is usually caused by the so-called "myeloma kidney" and is associated with shortened survival in patients treated with conventional therapy. Renal failure is reversible in up to 50% of patients, particularly when its degree is moderate and it is related to precipitating factors such as hypercalcemia. In our experience, approximately 10% of newly diagnosed patients with MM have renal failure severe enough to require dialysis. Despite its frequency, there are few reports dealing with MM and renal failure.
A Case of Multiple Myeloma and Renal Failure in a Young Patient  [PDF]
Muftah Othman, Eiman Homid, Mohamed Sadek, Ali Rahil, Awad Rashed
Open Journal of Nephrology (OJNeph) , 2016, DOI: 10.4236/ojneph.2016.64017
Abstract: Multiple myeloma is a malignant plasma cell disorder that affects the kidney with various clinical presentations. The most common renal manifestation of multiple myeloma is myeloma cast nephropathy. We are describing a young patient with multiple myeloma presented with back pain, anemia and renal impairment. The renal biopsy showed a myeloma cast nephropathy. She was treated with myeloma chemotherapy, high cut-off hemodialysis and autologous hematopoietic stem cell transplantation with good outcome. We report this rare case of multiple myeloma presented with myeloma cast nephropathy (MCN) in a young patient to describe the evidence of light chain removal strategies including plasmapheresis and high cut-off hemodialysis for the management of myeloma cast nephropathy.
Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure
Colin A Hutchison, Tim Plant, Mark Drayson, Paul Cockwell, Melpomeni Kountouri, Kolitha Basnayake, Stephen Harding, Arthur R Bradwell, Graham Mead
BMC Nephrology , 2008, DOI: 10.1186/1471-2369-9-11
Abstract: Sera from 142 patients with new dialysis-dependent renal failure were assessed by serum protein electrophoresis (SPE), FLC immunoassays and immunofixation electrophoresis. The sensitivity and specificity of the FLC ratio's published reference range was compared with the modified renal reference range for identifying patients with multiple myeloma; by receiver operating characteristic curve analysis.Forty one patients had a clinical diagnosis of multiple myeloma; all of these patients had abnormal serum FLC ratios. The modified FLC ratio range increased the specificity of the assays (from 93% to 99%), with no loss of sensitivity. Monoclonal FLCs were identified in the urine from 23 of 24 patients assessed.Measurement of serum FLC concentrations and calculation of the serum κ/λ ratio is a convenient, sensitive and specific method for identifying monoclonal FLC production in patients with multiple myeloma and acute renal failure. Rapid diagnosis in these patients will allow early initiation of disease specific treatment, such as chemotherapy plus or minus therapies for direct removal of FLCs.Immunoglobulin free light chains (FLCs) are by-products of immunoglobulin synthesis and in normal subjects are released into the circulation in small quantities [1]. The FLCs are then rapidly removed by renal clearance [2]. In patients with multiple myeloma, however, the clonal proliferation of plasma cells can produce FLCs in quantities thousands of times higher than normal [3]. These monoclonal FLCs often result in renal pathologies, most importantly cast nephropathy [4-6]. Indeed, multiple myeloma is the haematological malignancy most commonly associated with acute kidney injury (AKI) [7]. It has been proposed that the combination of multiple myeloma and AKI should be treated as a medical emergency with prompt diagnosis and intervention to avoid irreversible renal failure [8]. However, the standard screening tests for myeloma, serum protein electrophoresis (SPE) and urine Bence
Transplantation for renal failure secondary to enteric hyperoxaluria: a case report
Stephen I Rifkin
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-31
Abstract: Enteric hyperoxaluria may occur in patients with intestinal malabsorption from a variety of causes. Complications include oxalate stone disease, acute renal failure, and oxalate induced interstitial nephritis with the development of chronic renal insufficiency. There have been rare reports of renal transplantation for the resulting end stage renal disease and these reports have often been complicated by oxalate deposition and renal insufficiency or graft loss [1-5]. This report is of a patient with longstanding Crohn's disease, short bowel syndrome from surgery with resultant hyperoxaluria and renal failure secondary to recurrent stone disease. He underwent successful deceased donor renal transplantation without any post-op oxalate related complications and with satisfactory renal function almost three years post transplant.The patient is a 60 year old white male who had Crohn's disease diagnosed in the 1960's. He had small bowel resections in 1965 and 1969. He developed recurrent stone disease in the early 1980's. In 1999 24 hour urine studies showed an elevated oxalate excretion of 1.29 mmol (normal <0.50 mmol) and low magnesium, citrate, and calcium excretion. His serum creatinine was 2.0 mg% in 1995 and 2.5 mg% in Nov. 2001. In June, 2002 he presented with acute renal failure secondary to obstructive stone disease with a serum creatinine of 12.7 mg%. With correction of the obstruction his renal function only modestly improved and he was placed on hemodialysis on 7/29/02. His dialysis course was complicated by multiple blood access problems and several episodes of life-threatening sepsis. As a result he underwent deceased donor renal transplant on 3/9/04. Induction therapy consisted of basiliximab, mycophenolate mofetil, and steroids and then maintenance therapy with tacrolimus, sirolimus, and steroids was instituted. The patient did not undergo intensive hemodialysis either prior to or after transplantation. He did have an acute rejection episode. The biopsy sho
Amiloidosis extrema asociada a mieloma múltiple e insuficiencia renal terminal: Caso clínico Primary amyloidosis associated with multiple myeloma and renal failure: Case report
Camila Pe?a O,Marvila Intriago B,Ana María Gray H,María Elena Cabrera C
Revista médica de Chile , 2011,
Abstract: We report a 53-year-old female on chronic dialysis, presenting with weight loss, the development of big soft masses in the shoulders ("shoulder pads"), forearms and buttocks, macroglossia and rigidity of hands and lower limbs. Laboratory confirmed the presence of amyloidosis and myeloma with lambda chain restricted plasma cell infiltration of bone marrow. The diagnosis of multiple myeloma associated with primary amyloidosis in a patient with terminal renal failure, was reached.
Acute Renal Failure Secondary to Tuberculosis: A Diagnostic Challenge  [PDF]
Saeed I. Khilji,Hong Kuan Kok,Limy Wong,Anthony M. Dorman,J. Joseph Walshe
Case Reports in Nephrology , 2012, DOI: 10.1155/2012/510179
Abstract: Tuberculosis is a multiorgan disease with varied clinical presentations and is reemerging due to increasing immigration and globalization. We present the case of an immigrant female patient who developed acute renal failure with clinical and biochemical features suggestive of lupus nephritis but with a timely renal biopsy showing caseating granulomata in the renal parenchyma consistent with renal tuberculosis. Despite treatment with antituberculosis treatment and resolution of TB on repeat renal biopsy, she remained haemodialysis dependent. We discuss the diagnostic challenges faced in this presentation and also explore possible differential diagnoses. This rare presentation highlights the importance of renal biopsy in the diagnosis and treatment of acute renal failure and the atypical presentation of tuberculosis. 1. Introduction Tuberculosis (TB) is often seen as a disease of the past but has been reemerging in recent times [1]. The contemporary disease patterns and clinical presentations may be altered due to factors such as acquired immunodeficiency syndrome (AIDS) and globalization with immigration from TB endemic countries in Eastern Europe, Asia, and Africa. We report on an unusual case of acute renal failure secondary to renal tuberculosis where the initial clinical and serological picture was highly suggestive of lupus nephritis. We also briefly discuss the challenges in the diagnosis and management of this clinical presentation. 2. Case Presentation A 45-year-old female resident in Ireland, originally from the Philippines, was transferred to our institution for further management of acute renal failure. She initially presented to the referring hospital with generalized malaise and fatigue over the preceding month associated with a small, painless swelling on the left side of the neck. She denied any fevers, chills, rigors, night sweats, photosensitive rash, joint pains, weight loss, or urinary tract symptoms. She did not suffer from any upper respiratory tract symptoms, sinusitis, or rash. She was not taking any medications or herbal remedies. Her past medical history was unremarkable except for lumpectomy for a benign breast cyst several years ago. Her menstrual cycles were normal and there was no history of miscarriages in the past. Her serum creatinine on admission was 205?μmol/L with an active urine sediment. On examination, she appeared unwell, was afebrile, with a blood pressure 130/80?mmHg, and weighed 57?kgs. A bedside urine dipstick was positive for blood (+) and protein (+++). There was no evidence of oral ulceration, rashes, or
Acute airway failure secondary to thyroid metastasis from renal carcinoma
Mario Testini, Germana Lissidini, Angela Gurrado, Gaetano Lastilla, Amato Ianora, Raffaele Fiorella
World Journal of Surgical Oncology , 2008, DOI: 10.1186/1477-7819-6-14
Abstract: We report a case of a 73-year-old man with a painful neck mass, dyspnoea, stridor and dysphonia that was evaluated in emergency. A right radical nephrectomy for renal cell carcinoma was performed 8 years previously. An emergency endotracheal intubation was followed by total thyroidectomy. Histological examination confirmed the diagnosis of thyroid metastasis from renal cell carcinoma.A literature review regarding emergency treatment for acute respiratory compromise resulting from secondary thyroid tumours was undertaken. Only two cases of metastatic colon cancer and one case of metastatic meningioma requiring emergency thyroidectomy for acute respiratory failure are reported in the literature. This appears to be the first case of emergency surgery performed for acute respiratory compromise due to thyroid metastasis from renal cell carcinoma.Acute respiratory obstruction is an uncommon complication of thyroid disease. Most commonly it is due to hemorrhage within a multinodular goiter, bulky mediastinal goiter, anaplastic carcinoma or lymphoma [1-7]. Symptomatic metastases to the thyroid gland are rare, and patients usually complain of a palpable nodule, hoarseness, dysphagia and pain [8,9]. More rarely, it may present with breathing difficulty. In the present report, we describe a patient with thyroid metastases from renal cell carcinoma who presented clinically with acute respiratory failure. Two other similar cases reported in the medical literature are reviewed.A 73-year-old man was admitted in emergency to the general surgery department with a neck mass, sudden dyspnoea, stridor, dysphonia, and progressively worsening dysphagia. His medical history included a multinodular goiter ans right radical nephrectomy performed 8 years prior due to renal cell carcinoma. At annual follow-up, a CT of the thorax and abdomen was performed and the thyroid mass was also evaluated by ultrasonography and thyroid function tests. Five months earlier, the patient had undergone fine-n
Acute Renal Failure Secondary to Tuberculosis: A Diagnostic Challenge
Saeed I. Khilji,Hong Kuan Kok,Limy Wong,Anthony M. Dorman,J. Joseph Walshe
Case Reports in Nephrology , 2012, DOI: 10.1155/2012/510179
Abstract: Tuberculosis is a multiorgan disease with varied clinical presentations and is reemerging due to increasing immigration and globalization. We present the case of an immigrant female patient who developed acute renal failure with clinical and biochemical features suggestive of lupus nephritis but with a timely renal biopsy showing caseating granulomata in the renal parenchyma consistent with renal tuberculosis. Despite treatment with antituberculosis treatment and resolution of TB on repeat renal biopsy, she remained haemodialysis dependent. We discuss the diagnostic challenges faced in this presentation and also explore possible differential diagnoses. This rare presentation highlights the importance of renal biopsy in the diagnosis and treatment of acute renal failure and the atypical presentation of tuberculosis.
Brown tumors in patients with chronic renal failure and secondary hyperparathyroidism: Report of 12 cases  [cached]
Fatma Lilia,Barbouch Samia,Fethi Ben,Imen Ben
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Brown tumors are unusual but serious complications of renal osteodystrophy. We retrospectively studied 12 patients presenting with chronic renal failure and brown tumor related to secondary hyperparathyroidism. Eleven patients were on chronic hemodialysis. The median duration between renal failure and end stage renal failure was 36 months (range: 12-190 months) and the median duration in dialysis for 11 cases: 92 months (range: 72-252 months). The bone pain was noted in all cases (100%), pathological fracture in one case (8%) and a palpable bone tumor in 10 cases (83%). Elevated serum Calcium (> 2.35 mmol/L) was noted in four cases (33%), elevated serum Phosphate (> 1.78 mmol/L) in ten cases (80%), elevated serum Alkaline Phosphate (> 290 UI/L) in all cases and intact PTH was > 300 pg/mL in all cases with a serum median rate at 1475 pg/mL (range: 682-3687 pg/L). Subtotal parathyroidectomy was performed in all cases with a resultant decrease in size of brown tumors. We report here patient with CKD with unusual frequency and variable locations. This may be attributed tothe lack of the new calcium free phosphate binders and calcimimetics.
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