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Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study

2020Journal article Open access
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dc.contributor.authorRoyal, V
dc.contributor.authorLeung, N
dc.contributor.authorTroyanov, S
dc.contributor.authorNasr, Sh
dc.contributor.authorÉcotière, L
dc.contributor.authorLeBlanc, R
dc.contributor.authorAdam, BA
dc.contributor.authorAngioi, A
dc.contributor.authorAlexander, MP
dc.contributor.authorAsunis, AM
dc.contributor.authorBarreca, A
dc.contributor.authorBianco, PC
dc.contributor.authorCohen, C
dc.contributor.authorDrosou, ME
dc.contributor.authorFatima, H
dc.contributor.authorFenoglio, R
dc.contributor.authorGougeon, F
dc.contributor.authorGoujon, JM
dc.contributor.authorHerrera, GA
dc.contributor.authorKnebelmann, B
dc.contributor.authorLepori, N
dc.contributor.authorMaletta, F
dc.contributor.authorManso, RT
dc.contributor.authorMotwani, SS
dc.contributor.authorPani, A
dc.contributor.authorRabant, M
dc.contributor.authorRennke, HG
dc.contributor.authorRocatello, D
dc.contributor.authorRosenblum, F
dc.contributor.authorSanders, PW
dc.contributor.authorSantos, A
dc.contributor.authorSoto, K, et al.
dc.date.accessioned2020-07-06T15:41:30Z
dc.date.available2020-07-06T15:41:30Z
dc.date.issued2020
dc.description.abstractLight chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBlood. 2020 May 21;135(21):1833-1846pt_PT
dc.identifier.doi10.1182/blood.2019003807.pt_PT
dc.identifier.issn1528-0020
dc.identifier.urihttp://hdl.handle.net/10400.10/2455
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Society of Hematologypt_PT
dc.relation.publisherversionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243151/pt_PT
dc.subjectAcute kidney injurypt_PT
dc.titleClinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceWashington, DCpt_PT
oaire.citation.titleBloodpt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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