Hello, my name is Adis Kastritis, I'm a professor of medicine in Athens, in Greece. Today we had the opportunity to discuss with other colleagues the management of patients with myeloma who present with renal failure. Renal failure means that the kidneys do not work and this is one of the most common complications of this disease. It is a complication that requires immediate action and requires immediate action not only in terms of diagnosis but also in terms of therapy. It is very important to measure the free light change in the serum in the blood and decide whether there is a high risk for cast nephropathy. In such cases we have to start therapy immediately, within the same day if possible. The treatment in these cases is to administer higher doses of dexamethasone in combination with bortezomib, which is known as Velcade, and perhaps another drug, either cyclophosphamide or thalidomide. Today we also have monoclonal antibodies targeting CD38 on the plasma cells such as daratumum or isatuximab and it seems that if we combine all these drugs together we can rapidly induce a response of the myeloma which will be translated in most of the cases in an improvement in the function of the kidneys of the patient. This is very critical. Sometimes however we also have to do a renal biopsy in order to have the correct diagnosis about what is the type of the disease that has caused the renal failure in the patient. Of course this is more complicated and depends on the results of the laboratory tests in the blood and in the urine. However today we can say that we can recover renal function even in patients that require dialysis at this phase in about 50% of the patients and this is very very important. Unfortunately it seems that the use of some special dialysis is not helping as much as we expected so most of the results that we have is expected by the use of very effective anti-myeloma therapies.
