[Enhanced adsorption dialysis on acute kidney injury in micromolecular myeloma]

Acute kidney injury (AKI) is one of the mean causes of morbidity and mortality in patients with multiple myeloma. Approximately ten per cent of patients with diagnosis of multiple myeloma is in need of dialysis owing to AKI from accumulation of monoclonal free light chains (FLC) both K and lambda. In order to increasing their removal haemodialysis with protein-leaking dialyzers is necessary. It is clear that the series of filters with Polimetilmethacrylate (PMMA BK-F) is particularly able to absorb the FLC. The absorption has the greatest efficacy in the first hours of the dialysis, whereas it is almost lacking in the second part of dialysis, when the membrane is saturated. The Enhanced adsorption dialysis (EAD), trough the use of a second dialyzer, PMMA BK-F and of a second haematic line, doubles the absorption capacity. We describe the case of a 70 years old patient, that comes to our examination owing to AKI in anuria. The positive serum immunofixation through K chains and osteological lesions, marked by RX, at the backbone and at the braincase, arouse suspicions of micromolecular myeloma, so the patient underwent dialytic treatment in EAD with halving of FLC lambda values and a 33 per cent decrease, following recovery of diuresis and partial betterment of renal function parameters.