How is light chain nephropathy prevented?
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How is light chain nephropathy prevented?
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@arghyadeep Maintain adequate fluid intake (2-3 L/d), especially before initiating chemotherapy, to prevent dehydration. Dehydration and aciduria favors precipitation of light chains. This is important in the precipitation of acute renal failure in a significant number (up to 95%) of patients.
Avoid nephrotoxic agents. NSAIDs, often used to relieve bone pain, are the most prominent offenders.
Ensure early and effective treatment of infections with nonnephrotoxic antibiotics. Intravenous immunoglobulin has been found to be safe when used as prophylaxis against infection in the so-called plateau phase.
Early recognition and treatment of hypercalcemia are important. Excessive calcium is an important cause of acute renal failure in patients with myeloma and may be present in up to 30% of patients. Hypercalcemia impairs renal concentrating ability, thus leading to dehydration and promoting precipitation of light-chain proteins in renal tubules. Nausea, vomiting, and altered mental state associated with hypercalcemia further increase the likelihood of dehydration. Hypercalciuria also exerts a direct nephrotoxic effect and thus causes tubular degeneration and necrosis. Implement aggressive treatment of hypercalcemia, with saline diuresis, steroids, calcitonin, and diphosphonate.
Perform contrast studies judiciously in patients with multiple myeloma because of the possibility of contrast-induced renal failure. However, McCarthy and Becker reviewed 7 retrospective studies of patients with myeloma who were receiving contrast media and noted that the incidence rate of acute renal failure was only 0.6-1.25%, compared to 0.15% in the general population