Light Chain Cast Nephropathy: Practical Considerations in the Management of Myeloma Kidney—What We Know and What the Future May Hold

Purpose of review To update and evaluate the current knowledge on pathogenesis and management of light chain cast nephropathy. Light chain cast nephropathy (LCCN) is the leading cause of acute renal failure in patients with multiple myeloma and is currently recognized as a myeloma defining event. Re...

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Bibliographic Details
Published in:Current hematologic malignancy reports 2018-06, Vol.13 (3), p.220-226
Main Authors: Manohar, Sandhya, Nasr, Samih H., Leung, Nelson
Format: Article
Language:English
Subjects:
Geriatrics/Gerontology
Glomerulonephritis, Membranous - blood
Glomerulonephritis, Membranous - etiology
Glomerulonephritis, Membranous - therapy
Glomerulonephritis, Membranous - urine
Hematology
Humans
Immunoglobulin Light Chains - blood
Immunoglobulin Light Chains - urine
Medicine
Medicine & Public Health
Multiple Myeloma (P Kapoor
Multiple Myeloma - blood
Multiple Myeloma - complications
Multiple Myeloma - therapy
Multiple Myeloma - urine
Oncology
Section Editor
Topical Collection on Multiple Myeloma
Uromodulin - blood
Uromodulin - urine
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Summary:Purpose of review To update and evaluate the current knowledge on pathogenesis and management of light chain cast nephropathy. Light chain cast nephropathy (LCCN) is the leading cause of acute renal failure in patients with multiple myeloma and is currently recognized as a myeloma defining event. Recent findings The immunoglobulin free light chain plays an integral role in the pathogenesis of LCCN. The level of free light chain (FLC) in the blood and urine is directly associated with the risk of developing LCCN. Recovery of renal function is related to the speed and degree of the serum FLC reduction. Recently, two randomized trials using high cutoff dialyzer for the removal of serum FLC produced different results in terms of renal recovery. Summary FLC plays a key role in the development and resolution of LCCN. Future therapies will aim to rapidly reduce its concentration or interrupt its interaction with Tamm-Horsfall protein.
ISSN:1558-8211
1558-822X
DOI:10.1007/s11899-018-0451-0