A 46-year-old patient with no history of interest came to the emergency room for pain in the left testis radiating to the ipsilateral flank, without fever or accompanying voiding syndrome.
Physical disturbance, except hypertension
Renal and testicle-prostatic echocardiography was unremarkable.
Deterioration of rapidly progressive renal function (creatinine 9.79 mg/dl, 4.85 g/24 proteinuria without active sediment) and progressive anemization (Hb 8.1 g/dl, mean corpuscular hemoglobin concentration 314) were observed.
Immunological study (antinuclear antibodies, neutrophil cytoplasmic antibodies, anti-GBM, anti-streptococcal antibodies, rheumatoid factor, C3-4), viral serology and tumour markers, normal
Proteinogram-immunofixation with monoclonal immunoglobulin (Ig)A-kappa band.
IgG 317, 1446, IgM 15 mg/dl, light chain free IgA (CLL, nefel free-Lite®) kappa 4090 ng/ml, lambda 1.
Albumin 10.8, LDH 269, calcium 10.2, albumin 3.3, B2 microglobulin 23340.
Hepatic and lipid profile and blood count were normal.
Pathologically, we diagnosed nephropathy by light chains kappa (CLL-K) and MM IgA-kappa stage IIIB Durie Salmon, starting treatment with the bortezomib filter.
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During the following two months, serum IgA levels decline progressively and significantly, but not pre-dialysis CLL-K levels, but it is decided in a multidisciplinary clinical session to continue the treatment established according to the protocol of hematology.
In the rebiopsy, chronic tubulointerstitial lesions of mild intensity are observed, prescribing 6 more cycles of high cut-off dialysis.
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Three months after the diagnosis, after 4 cycles of chemotherapy, the ineffectiveness of bortezomib, sustitu and lenalidomide adjusted for renal function is determined.
Due to economic reasons, it is impossible to continue the purifying therapy of FLC (having received a total of 18 sessions), treating the patient in renal therapy with conventional high-flow dialysis.
The efficacy of lenalidomide (Task consolidation, SW and EMBT) is confirmed, under which the patient is three years after diagnosis, in addition to the renal replacement therapy.
