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Myeloma cast nephropathy — ESENeph MCQ

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HardGlomerulonephritisMyeloma cast nephropathyESENeph

A patient with newly diagnosed multiple myeloma has dialysis-requiring AKI and serum involved free light chains of 8,500 mg/L. Biopsy confirms cast nephropathy. Which intervention is most important for renal recovery?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Start urgent clone-directed treatment to reduce circulating free light chains

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

E is correct. Renal recovery in cast nephropathy depends chiefly on rapid suppression of pathogenic free light-chain production with an effective clone-directed regimen, coordinated urgently between haematology and nephrology. Supportive measures include correcting volume depletion and hypercalcaemia and avoiding nephrotoxins. Extracorporeal light-chain removal cannot substitute for chemotherapy; evidence for routine high-cut-off dialysis improving patient-centred outcomes is insufficient. Delaying treatment allows continued tubular obstruction and toxicity. Serial free light chains provide an early measure of biochemical response while dialysis supports life-threatening complications.

Reference: NICE NG35: myeloma diagnosis and management: https://www.nice.org.uk/guidance/ng35/chapter/Recommendations