A recent review of the pathophysiology of light chain damage in the kidney suggests some novel findings.
1. Apoptosis is a feature of experimental monoclonal free light chains( FLC) induced renal injury in animals which might be underlying mechanism in proximal tubulopathy.
2. Cast nephropathy experimental evidence suggests that intraluminal casts formation is the proximate cause of AKI and the most likely first step in the progressive decline of the renal function.
3. When IV infusion of monoclonal FLC was given in rats, elevated proximal tubular pressures were noted and decrease in single nephron GFR with formation of intraluminal protein casts.
4. The FLCs optimal bind via their CDR3 receptor to the Tamm-Horsfall protein in the distal nephron.
5. A inhibitor of the CDR3 part of FLC in rodents inhibited the cast formation.
6. While chemotherapy is the most effective, increasing water intake, avoiding nephrotoxic agents when the FLC burden is high is extremely important.
7. Renal risk from myeloma is very dependent on the circulating monoclonal FLC rather than the M protein.
8. Advent of FLC assays have really helped the diagnosis and management of renal dysfunction seen in patients with paraproteinemias.
Figure reference: the binding site
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ANP and AKI
- IN the news: The CANDY Study
- Uncomplicated Urinary Tract infections: New guidel...
- IN THE NEWS: SuPAR and FSGS more data revealed
- Free light chain induced Acute Kidney Injury- mech...
- Clinical Case 64: Answers and Summary
- Costs of Care education initiative? Where do nephr...
- 20 Years of Uptodate.com
- Secondary Causes of Cryoglobulinemia associated G...
- Donor evaluation and follow ups- a new ruling!
- IN THE NEWS: Nephrology NEJM showcase
- First Annual ASN Fellows in Training Bowl( FIT Bow...
- Are Nephrologists and their patients ready for Nat...
- Topic Discussion: Cholemic Nephrosis
- eAJKD and NOD: ASN 2012
- Clinical Case 63: Answers and Summary
- ASN Podcasts
- History of hope
- ▼ November (18)
- ► 2011 (370)
- ► 2010 (461)