Light Chain-Associated Renal Disorders Medication

Updated: Sep 10, 2019
  • Author: Malvinder S Parmar, MBBS, MS, FRCPC, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Medication

Medication Summary

No standard treatment has been established for light-chain nephropathy, and the mainstay remains treatment of the underlying disease process and monitoring for complications and early recognition and management of complications.

In patients with myeloma, prevention of cast nephropathy is the mainstay by reducing the production of light chains by dexamethasone-based chemotherapy and promoting light chain filtration by optimizing volume status and intravenous fluid therapy to maintain urine volume of approximately 3 L/day, unless contraindicated, and alkalization of urine.

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Antineoplastic agents

Class Summary

The mainstay of treatment is effective control of the underlying (primary) disease. A combination of an alkylating agent (eg, melphalan) and prednisolone, administered for 4-7 d q4-6wk, is the standard first-line approach and induces remission in approximately 40% of patients. This combination does not act rapidly, and the dose of melphalan often must be modified because the drug is excreted via the kidney.

Bortezomib (Velcade)

First drug approved of anticancer agents known as proteasome inhibitors. The proteasome pathway is an enzyme complex existing in all cells. This complex degrades ubiquitinated proteins that control the cell cycle and cellular processes and maintains cellular homeostasis. Reversible proteasome inhibition disrupts pathways supporting cell growth, thus decreases cancer cell survival.

Bortezomib-based chemotherapy, in addition to early plasmapheresis, in patients with multiple myeloma and kidney failure secondary to myeloma cast nephropathy has shown to achieve complete renal recovery in 40% of patients and is preferred therapy in this subset of patients. [18]

Melphalan (Alkeran)

Inhibits mitosis by cross-linking DNA strands. Effective against both resting and rapidly dividing tumor cells.

Vincristine (Vincasar PFS, Oncovin)

Inhibits cellular mitosis by inhibiting intracellular tubulin function and binding to microtubules and spindle proteins in the S phase.

Doxorubicin (Adriamycin, Rubex)

Inhibits topoisomerase II and produces free radicals, which may cause the destruction of DNA. The combination of these events can, in turn, inhibit the growth of neoplastic cells.

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Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisone (Deltasone, Meticorten, Orasone)

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production. Reduced to its pharmacologically active form, prednisolone.

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