L BELL 1, Z LI 1, B CHACKO 1
1Hunter New England LHD, Newcastle, Australia
Aim: To evaluate the prognosis of patients presenting with acute kidney injury (AKI) and myeloma cast nephropathy (MCN), and the impact of different treatment strategies in these patients.
Background:MCN carries significant mortality and morbidity, including dialysis-dependence. The prognostic value of renal biopsies in MCN is debated, as are benefits of novel therapies and high cut-off dialysis (HCOD). This study contributes to these discussions and evaluates the prognosis of patients presenting with AKI and membranous cast nephropathy.
Methods:A retrospective study over two years was conducted on 57 patients from our centre from 1992-2018. Patients presented with an acute kidney injury with biopsy-confirmed MCN. Patients were divided into either treatment “Responsive” or “Non-Responsive” based on dialysis dependence and eGFR at 3 months, with a cut-off of greater than 30ml/min/1.73m2. Baseline characteristics, treatment strategy and follow-up information was collected and compared across these groups.
Results: 37 patients were included for analysis, 27 responded to treatment and 10 did not at 3 months. Mean survival from presentation was 17.5 months. Significantly lower mortality at 1 year and lower dialysis-dependence at 1 and 2 years was found for “Responder” patients. Severity of acute kidney injury was a significant factor determining response to treatment. Severity of median tubular atrophy and interstitial fibrosis was higher in “Non-Responder” patients. Use of high-cut off dialysis (HCOD) and more modern bortezomib-based therapy had favourable results, with HCOD significantly improving mortality at 1-year.
Conclusion: For patients presenting with AKI and MCN, progress at 3 months has a significant impact on prognosis. HCOD and bortezomib therapies appear to have improved outcomes, and increased tubular atrophy/interstitial fibrosis trended towards worse prognosis.
Liam Bell is a Critical Care Senior Resident Medical Officer in Newcastle, NSW. He wishes to pursue a career in intensive care and has a particular interest in nephrology, garnered during a term with the Nephrology and Transplantation Department at John Hunter Hospital. Currently, he is performing research on multiple myeloma cast nephropathy and membranous nephropathy with the team at John Hunter Hospital.