If you don’t like to read, you haven’t found the right book

What is cast nephropathy?

Specialty. Nephrology. Myeloma cast nephropathy, also referred to as light-chain cast nephropathy, is the formation of plugs (urinary casts) in the kidney tubules from free immunoglobulin light chains leading to kidney failure in the context of multiple myeloma. It is the most common cause of kidney injury in myeloma.

What causes cast nephropathy?

Cast nephropathy is caused by the interaction and aggregation of filtered free light chains and Tamm–Horsfall protein causing intratubular obstruction and damage. The key to treating cast nephropathy is rapid lowering of free light chains, because this correlates with renal recovery.

How is cast nephropathy treated?

The key to treating cast nephropathy is rapid lowering of FLCs as this correlates with renal recovery. Newer chemotherapy agents lower FLCs and have been referred to as “renoprotective”. However there remains great interest in using various extracorporeal therapies to remove serum FLCs.

What is light chain nephropathy?

Light chain cast nephropathy (LCCN) is the most common renal disease caused by multiple myeloma (MM). In addition to ordinary light chain protein casts, there are a few rare casts with unique shapes, including light chain amyloid casts (LCAC) and light chain crystal casts (LCCC).

What is tubular nephritis?

Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI) that can lead to chronic kidney disease (CKD). TIN is associated with an immune-mediated infiltration of the kidney interstitium by inflammatory cells, which may progress to fibrosis.

How is cast nephropathy diagnosed?

Diagnostic Evaluation In patients with MM and renal insufficiency, the likelihood of cast nephropathy can be determined by measuring serum FLC concentration and urinary albumin excretion.

Can multiple myeloma cause renal failure?

Renal failure is a common feature of multiple myeloma (MM) that may provide a clue to diagnosis and cause a major management problem. Depending on the definition of renal failure, this complication occurs in 20–40% of newly diagnosed patients with MM.

Is light chain myeloma worse?

When myeloma progresses, the myeloma cells start to produce more light chains than heavy chains. This can be measured by the Free Light Chain Assay test on a blood specimen. In general, the higher the free light chains, the more aggressive the disease is.

What do elevated light chains mean?

If the amount of free light chains is higher or lower than normal, it can mean you have a disorder of the plasma cells. These include multiple myeloma, a cancer of plasma cells, and amyloidosis, a condition that causes a dangerous buildup of proteins in different organs and tissues.

What is the ICD 10 cm code for unspecified nephritic syndrome?

Unspecified nephritic syndrome with other morphologic changes 1 N05.8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 Short description: Unsp nephritic syndrome with other morphologic changes 3 The 2020 edition of ICD-10-CM N05.8 became effective on October 1, 2019.

What are the clinical features of cast nephropathy?

Other factors favoring the development of cast nephropathy include a low urine flow rate as may occur during volume depletion, hypercalcemia, and diuretic or NSAID use. Clinical findings include features of myeloma, including a serum and urine paraprotein, and, occasionally, evidence of Fanconi syndrome (proximal RTA, glycosuria).

Is there such a thing as bile cast nephropathy?

Thus, bile cast nephropathy is an appropriate term for the severe form of injury observed in the spectrum of cholemic nephrosis. Additional studies are needed to establish the significance of this parameter for patient management in different clinical settings.

Is the hyaline cast of Tamm Horsfall nephropathy?

Hyaline casts of Tamm-Horsfall protein are found in many biopsy specimens and should not be confused with those of cast nephropathy.