Download Multiple myeloma and plasmapheresis PowerPoint Presentation

Login   OR  Register

Share page


Home / Health & Wellness / Health & Wellness Presentations / Multiple myeloma and plasmapheresis PowerPoint Presentation

Multiple myeloma and plasmapheresis PowerPoint Presentation

onlinesearch By : onlinesearch

On : Feb 24, 2014

In : Health & Wellness

Embed :

Login / Signup - with account for

  • → Make favorite
  • → Flag as inappropriate
  • → Download Presentation
  • → Share Presentation
  • Slide 1 - Cast Nephropathy & Plasmapheresis Alicia Notkin February 6, 2008
  • Slide 2 - Pathogenesis of cast nephropathy Renal failure from immunoglobulin or κ or λ light chains: direct tubular toxicity & obstruction Light chains (MW 22000) are freely filtered across the glomerulus & then reabsorbed by proximal tubular epithelial cells
  • Slide 3 - Pathogenesis of cast nephropathy Overproduction of light chains  tubular capacity for reabsorption is exceeded Filtered light chains & immunoglobulins then bind Tamm-Horsfall glycoprotein (secreted in the medullary TAL of the loop of Henle) Cast formation & obstruction in the distal nephron subsequently results
  • Slide 4 - Pathogenesis of cast nephropathy(Sanders 1990) Bence Jones proteins  loop segment dysfunction  decreased NaCl absorption  increased early distal tubule NaCl concentration which promotes aggregation/cast formation (shown in rats in vivo) Proteins w/ isoelectric points > 5.1 aggregate w/ THP in vitro (increasing NaCl or CaCl2 concentration enhances aggregation); in vivo, not all cationic proteins  casts (partly b/c of differences in distal nephron NaCl concentration & b/c of variable affinity of the immunoglobulin light chains to the binding site on the THP)
  • Slide 5 - % change in turbidity (from co-precipitation) v. NaCl concentration for in vitro solutions of THP w/ various low molecular weight proteins(Sanders 1990)
  • Slide 6 - Pathogenesis of cast nephropathy:in vivo rat data (Sanders 1992) Obstruction occurred in the distal nephron only & showed direct BJP-concentration dependence Obstruction took significantly longer to develop in rats given volume infusion at high rates Obstruction developed more rapidly with increasing furosemide concentrations Colchicine prevented obstruction by decreasing tubular secretion & carbohydrate content of THP
  • Slide 7 - Change in turbidity of in vitro solutions of rat THP +/- colchicine w/ increasing concentrations of furosemide (Sanders 1992)
  • Slide 8 - Compounding factors… Hypercalcemia Hyperuricemia Infection Volume depletion or loop diuretics Nephrotoxic drugs, IV contrast Proximal tubular injury from light chain reabsorption & interference w/ lysosomal function; cycle whereby dysfunction  further decrease in light chain reabsorption
  • Slide 9 - Treatment of cast nephropathy Volume repletion: decrease tubular light chain concentration, decrease tubular NaCl concentration Increase urine flow: decrease light chain precipitation Alkalinize urine: raise urine pH above isoelectric point to decrease affinity toward anionic Tamm-Horsfall proteins (controversial) Chemotherapy to decrease immunoglobulin production
  • Slide 10 - Plasmapheresis to remove circulating free light chains? Many studies are small, non-randomized, retrospective, are heterogeneous… 3 prospective, randomized trials: 2 favor plasmapheresis, while most recent one casts doubt on its use
  • Slide 11 - Plasmapheresis? Zucchelli 1988: 29 patients (24/83% req dialysis), 59% biopsied, Cr > 5mg/dl not responsive to hydration, 80% treated previously w/ cytotoxic drugs, all given methylprednisolone & cyclophosphamide & randomized to plasmapheresis w/ prn HD vs. prn PD; 13/15 v. 2/14 w/ renal improvement; also survival benefit
  • Slide 12 - Plasmapheresis? Johnson 1990: 21 patients (57% req dialysis), 76% biopsied, all given melphalan, prednisone, & forced diuresis, 11 plasmapheresed, subgroup analysis of dialysis dependent patients – renal recovery in 47% pheresed v. 0% control
  • Slide 13 - Plasmapheresis? Clark 2005: 97 patients (26 v. 36% initially on dialysis in plasmapheresis v. control group), few biopsied, treated w/ vincristine, adriamycin, dexamethasone or melphalan & prednisone, +/- plasmapheresis, no statistically significant difference in composite endpoint of death, dialysis dependence, gfr < 30 ml/min @ 6 months
  • Slide 14 - Plasmapheresis? Leung 2007: retrospective study in 40 patients, cast nephropathy in 18/28 patients (64.3%) that were biopsied, w/ these patients having renal response associated w/ >/= 50% reduction in sFLC levels (77.8% v. 0%, p = 0.001), & w/ sFLC reduction not affecting renal recovery in the other 10 patients, post-treatment sFLC level predicted renal response (p = 0.01) & renal response predicted long-term survival (p = 0.04) – median survival 31.8 v. 11 months
  • Slide 15 - References Clark, WF et al. Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 2005; 143:777. Huang, ZQ et al. Localization of a single binding site for immunoglobulin light chains on human Tamm-Horsfall glycoprotein. J Clin Invest 1997; 99:732. Johnson, WJ et al. Treatment of renal failure associated with multiple myeloma. Plasmapheresis, hemodialysis, and chemotherapy. Arch Intern Med 1990; 150:863. Leung, N et al. Plasma exchange is an important and useful adjuvant therapy in cast nephropathy. XIth International Myeloma Workshop and IVth International Workshop in Waldenstrom’s Macroglobulinemia 2007. Sanders, PW et al. Mechanisms of intranephronal proteinaceous cast formation by low molecular weight proteins. J Clin Invest 1990; 85:570. Sanders, PW et al. Pathobiology of cast nephropathy from human Bence Jones proteins. J Clin Invest 1992; 89:630. Zucchelli, P et al. Controlled plasma exchange trial in acute renal failure due to multiple myeloma. Kidney Int 1988; 33:1175.
Dieting Free PowerPoint Template


Views : 391

Virtual Identity Free PowerPoint Template

Virtual Identity

Views : 426

DNA Free PowerPoint Template


Views : 463

Obesity Free PowerPoint Template


Views : 745

Credit Debit Card Free PowerPoint Template

Credit Debit Card

Views : 412

Easter Eggs Free PowerPoint Template

Easter Eggs

Views : 618

Question Free PowerPoint Template


Views : 510

Smoking Free PowerPoint Template


Views : 450

Statistics and Graph Free PowerPoint Template

Statistics and Graph

Views : 645

Social Media Words Free PowerPoint Template

Social Media Words

Views : 408

Email Symbol Free PowerPoint Template

Email Symbol

Views : 456

Success Achievement Free PowerPoint Template

Success Achievement

Views : 460

Whilte Tulip Free PowerPoint Template

Whilte Tulip

Views : 490

Lab Equipment Free PowerPoint Template

Lab Equipment

Views : 451

Health Tips Free PowerPoint Template

Health Tips

Views : 1025

Back to School Free PowerPoint Template

Back to School

Views : 493

Coffee Free PowerPoint Template


Views : 818

Guitar Free PowerPoint Template


Views : 884

Yoga Free PowerPoint Template


Views : 2341

Yoga Meditation Free PowerPoint Template

Yoga Meditation

Views : 741

Description : Available Multiple myeloma and plasmapheresis powerpoint presentation for free download which is uploaded by search an active user in belonging ppt presentation Health & Wellness category.

Tags : Multiple myeloma and plasmapheresis

Shortcode : Get Shareable link