Myeloma Progression from Cast Nephropathy — ESENeph MCQ
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Correct answer: E — Bortezomib-based clone reduction, dexamethasone and supportive renal care
Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E
D is correct. Cast nephropathy is itself a myeloma-defining emergency: rapid reduction of nephrotoxic free light chains offers the best chance of renal recovery. Bortezomib-based therapy and dexamethasone can begin promptly while full haematological classification proceeds, alongside hydration where safe, avoidance of nephrotoxins and management of hypercalcaemia or infection. A repeats the frozen conceptual error by waiting for another CRAB feature. B and E make extracorporeal removal a substitute for stopping light-chain production; evidence does not support that strategy. C addresses skeletal disease rather than the causal clone and may be unsafe in severe AKI.
Reference: How I treat light-chain cast nephropathy: https://pmc.ncbi.nlm.nih.gov/articles/PMC11108236/