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This tubulointerstitial lesion is a direct consequence of the high concentration of circulating monoclonal free light chains (FLCs) that are produced by a clonal proliferation of plasma cells.
Recent work has demonstrated that renal recovery in patients with myeloma kidney occurs when an early reduction in serum concentration of monoclonal FLCs is achieved.
The degree of very early FLC reduction (day 12) both preceded renal recovery and subsequently predicted the duration of dialysis dependence.
In the dialysis-dependent patients there was a median reduction in serum FLC levels of 62% (range 0 to 95%) by day 12 and the median time to independence of dialysis was 27 days (7 to 170).
Patient survival strongly associated with renal recovery: the median survival was 42.7 months (range 0 to 80) among those who recovered function compared with 7.8 months (range 0 to 54) among those who did not ( Renal function strongly predicts the survival of patients with multiple myeloma.
Fifteen percent were known to have a monoclonal gammopathy of undetermined significance (MGUS) before diagnosis.
Of these, 23 were male and the median age of the population was 62 years.
Patient characteristics from both institutions are provided in Table 1.
The presence of significant fibrosis on the kidney biopsy was associated with a nonsignificant reduction in the rate of renal recovery (Table 4).
Additionally, patients who had both light chain deposition disease (LCDD) and myeloma kidney present on renal biopsy had a nonsignificantly reduced chance of renal recovery (2 of 5; Table 4).