Kidney Week

Abstract: TH-PO269

Complete Kidney Recovery after Prolonged Hemodialysis Dependency in Multiple Myeloma-Associated Kidney Failure: A Case Report

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Cho, Hyun Joon, Mount Sinai Health System, New York, New York, United States

Hyun Joon Cho, MD

• Rao, Bassam Hamid, Shifa College of Medicine, Islamabad, Pakistan

Bassam Hamid Rao, MD, MBBS

• Mukhtar, Minahil, Shifa College of Medicine, Islamabad, Pakistan

Minahil Mukhtar, MD, MBBS

• Kim, Jee Hyun, Mount Sinai Health System, New York, New York, United States

Jee Hyun Kim, DO

• Teferici, Stela, Mount Sinai Health System, New York, New York, United States

Stela Teferici, MD

• Bakro, Mohamad, Mount Sinai Health System, New York, New York, United States

Mohamad Bakro, MBBS

• Maldonado, Dawn, Mount Sinai Health System, New York, New York, United States

Dawn Maldonado, MD

• Khan, Hameeda Tayyab, Mount Sinai Health System, New York, New York, United States

Hameeda Tayyab Khan, MD

• Munoz Casablanca, Nitzy N., Mount Sinai Health System, New York, New York, United States

Nitzy N. Munoz Casablanca, MD

Introduction

Renal impairment is an important complication of Multiple Myeloma (MM), with 20-40% of patients demonstrating some renal injury at diagnosis, related primarily to light chain cast nephropathy. Bortezomib and steroid based therapy are the backbone for MM management, compounded with hemodialysis in patients with renal failure. Here, we present a case of MM associated renal failure requiring hemodialysis for 11 months, with subsequent spontaneous renal recovery.

Case Description

A 49 year-old male, without any significant past medical/surgical history who had 1 month of intermittent urinary symptoms, weakness, nausea and loss of appetite and was prompted to come to the ED when outpatient workup revealed anemia with Hb 8.4 g/dL and serum creatinine (Cr) levels of 11 mg, without known previous baseline. Initial workup showed markedly elevated serum lambda light chains at 1435 mg/dL. Urinalysis with trace protein, but a urine protein creatinine ratio of 3.5g. The patient underwent kidney biopsy which came back positive for light chain (myeloma) cast nephropathy, lambda type, minimal interstitial fibrosis, tubular atrophy and unremarkable vessels. Bone marrow biopsy was also consistent with multiple myeloma.
He was initiated on renal replacement therapy and continued for 11 months. Patient was treated with cyclophosphamide, bortezomib and dexamethasone and then subsequently with Bortezonib, Lenalidomide and Dexamethasone. After being on hemodialysis for 11 months, his eGFR gradually improved, and a decision was made to withhold hemodialysis. Since then, the patient’s renal function has been stable, with Cr around 2 mg/dL and eGFR >30.

Discussion

The burden of renal disease in MM can be ascertained from its place as the second leading cause of mortality, with lack of renal recovery bearing a poor prognosis. In recent times, high cut-off hemodialysis has emerged as an adjunct to steroids and bortezomib based chemotherapy in this class of patients for improving renal outcomes. The data on this however, remains sparse. Although the patient was managed as per standard guidelines, our unique case signifies the potential space of renal recovery even after prolonged hemodialysis dependance in MM patients.