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

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA

    Sandhya Manohar & Nelson Leung

  2. Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology and Pathology Mayo Clinic, Rochester, MN, USA

    Samih H. Nasr

  3. Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55901, USA

    Nelson Leung

Authors
  1. Sandhya Manohar
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  2. Samih H. Nasr
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  3. Nelson Leung
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Correspondence to Nelson Leung.

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This article is part of the Topical Collection on Multiple Myeloma

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Manohar, S., Nasr, S.H. & Leung, N. Light Chain Cast Nephropathy: Practical Considerations in the Management of Myeloma Kidney—What We Know and What the Future May Hold. Curr Hematol Malig Rep 13, 220–226 (2018). https://doi.org/10.1007/s11899-018-0451-0

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  • DOI: https://doi.org/10.1007/s11899-018-0451-0

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