array:21 [
  "pii" => "X2013251412000601"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
  "estado" => "S300"
  "fechaPublicacion" => "2012-01-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:15-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9531
    "formatos" => array:3 [
      "EPUB" => 309
      "HTML" => 8324
      "PDF" => 898
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512000604"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
      "estado" => "S300"
      "fechaPublicacion" => "2012-01-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:15-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 21483
        "formatos" => array:3 [
          "EPUB" => 309
          "HTML" => 20046
          "PDF" => 1128
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Valor del ensayo de las cadenas ligeras libres en suero para los pacientes de gammapatías monoclonales e insuficiencia renal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "15"
            "paginaFinal" => "19"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The value of serum free light chain assay in patients with monoclonal gammopathies and renal failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11098_108_19760_es_11098_f1.jpg"
                "Alto" => 398
                "Ancho" => 600
                "Tamanyo" => 286192
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Cadenas ligeras libres y el riñón"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M. Luisa Campos, Nuno M. Barbosa-de Carvalho, Guillermo Martín-Reyes"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M. Luisa"
                "apellidos" => "Campos"
              ]
              1 => array:2 [
                "nombre" => "Nuno M."
                "apellidos" => "Barbosa-de Carvalho"
              ]
              2 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Martín-Reyes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412000601"
          "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000601?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000604?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000001/v0_201502091357/X0211699512000604/v0_201502091357/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412000589"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Nov.11065"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:20-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8821
      "formatos" => array:3 [
        "EPUB" => 341
        "HTML" => 7592
        "PDF" => 888
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Renal supportive care and palliative care: revision and proposal in kidney replacement therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "20"
          "paginaFinal" => "27"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Cuidados de soporte renal y cuidados paliativos renales: revisión y propuesta en terapia renal sustitutiva"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11065_16025_25899_en_t1_11065.jpg"
              "Alto" => 1042
              "Ancho" => 1080
              "Tamanyo" => 1052674
            ]
          ]
          "descripcion" => array:1 [
            "en" => "The four principles of modern bioethics"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "JUAN PABLO LEIVA-SANTOS, Juan P. Leiva-Santos, ROSA SANCHEZ HERNANDEZ, Rosa Sánchez-Hernández, HELENA GARCÍA-LLANA, Helena García-Llana, MARÍA JOSÉ FERNÁNDEZ-REYES, M. José Fernández-Reyes, MANUEL HERAS BENITO, Manuel Heras-Benito, ÁLVARO Molina Ordas, Álvaro Molina-Ordas, ASTRID Rodríguez, Astrid Rodríguez, FERNANDO Álvarez-Ude, Fernando Álvarez-Ude"
          "autores" => array:16 [
            0 => array:2 [
              "nombre" => "JUAN PABLO"
              "apellidos" => "LEIVA-SANTOS"
            ]
            1 => array:2 [
              "nombre" => "Juan P."
              "apellidos" => "Leiva-Santos"
            ]
            2 => array:2 [
              "nombre" => "ROSA"
              "apellidos" => "SANCHEZ HERNANDEZ"
            ]
            3 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Sánchez-Hernández"
            ]
            4 => array:2 [
              "nombre" => "HELENA"
              "apellidos" => "GARCÍA-LLANA"
            ]
            5 => array:2 [
              "nombre" => "Helena"
              "apellidos" => "García-Llana"
            ]
            6 => array:2 [
              "nombre" => "MARÍA JOSÉ"
              "apellidos" => "FERNÁNDEZ-REYES"
            ]
            7 => array:2 [
              "nombre" => "M. José"
              "apellidos" => "Fernández-Reyes"
            ]
            8 => array:2 [
              "nombre" => "MANUEL"
              "apellidos" => "HERAS BENITO"
            ]
            9 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Heras-Benito"
            ]
            10 => array:2 [
              "nombre" => "ÁLVARO"
              "apellidos" => "Molina Ordas"
            ]
            11 => array:2 [
              "nombre" => "Álvaro"
              "apellidos" => "Molina-Ordas"
            ]
            12 => array:2 [
              "nombre" => "ASTRID"
              "apellidos" => "Rodríguez"
            ]
            13 => array:2 [
              "nombre" => "Astrid"
              "apellidos" => "Rodríguez"
            ]
            14 => array:2 [
              "nombre" => "FERNANDO"
              "apellidos" => "Álvarez-Ude"
            ]
            15 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Álvarez-Ude"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512000581"
        "doi" => "10.3265/Nefrologia.pre2011.Nov.11065"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000581?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000589?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000589/v0_201502091620/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141200061X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Nov.11167"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:12-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5983
      "formatos" => array:3 [
        "EPUB" => 334
        "HTML" => 4874
        "PDF" => 775
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Longitudinal observational studies and causality"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "12"
          "paginaFinal" => "14"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudios observacionales longitudinales y causalidad"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alfonso Muriel, Domingo Hernández-Marrero, Víctor Abraira"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Muriel"
            ]
            1 => array:2 [
              "nombre" => "Domingo"
              "apellidos" => "Hernández-Marrero"
            ]
            2 => array:2 [
              "nombre" => "Víctor"
              "apellidos" => "Abraira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512000612"
        "doi" => "10.3265/Nefrologia.pre2011.Nov.11167"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000612?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200061X?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000001/v0_201502091620/X201325141200061X/v0_201502091620/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "The value of serum free light chain assay in patients with monoclonal gammopathies and renal failure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "15"
        "paginaFinal" => "19"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M. Luisa Campos, Nuno M. Barbosa-de Carvalho, Guillermo Martín-Reyes"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "M. Luisa"
            "apellidos" => "Campos"
            "email" => array:1 [
              0 => "luisa.campos@bindingsite.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno M&#46;"
            "apellidos" => "Barbosa-de Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Guillermo"
            "apellidos" => "Mart&#237;n-Reyes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => " The Binding Site Spain, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => " Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Valor del ensayo de las cadenas ligeras libres en suero para los pacientes de gammapat&#237;as monoclonales e insuficiencia renal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25688_en_f1_11098.jpg"
            "Alto" => 1311
            "Ancho" => 2089
            "Tamanyo" => 1893534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Free light chains and the kidney"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Monoclonal gammopathies &#40;MG&#41; are blood dyscrasias that result from a neoplastic process in plasma cell &#40;PC&#41; clones&#44; and are usually associated with an elevated production of a monoclonal protein &#40;MP&#41;&#46; This paraprotein can be an intact immunoglobulin or a light chain &#40;LC&#41;&#46; The immunoglobulins are composed of an identical pair of heavy chains joined to two identical kappa &#40;&#954;&#41; or lambda &#40;&#955;&#41; LC&#46; The heavy and light chains are produced separately&#44; and are later joined and secreted into the bloodstream&#46; In order to ensure correct conformation of the immunoglobulins&#44; PC produce an excess of LC&#44; whose surplus is secreted along with the com&#173;pleted immunoglobulins&#46; In this manner&#44; 40&#37; of LC are found free in the serum&#44; not joined to heavy chains&#46;<span class="elsevierStyleSup">1 </span>These serum free light chains &#40;sFLC&#41; have a different conformation&#58; &#954;FLC present as 25kDa monomers&#44; whereas &#955;FLC form 50kDa dimers&#46; </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DIAGNOSING MONOCLONAL GAMMOPATHIES </span></p><p class="elsevierStylePara">The diagnosis of MG is based on detecting the circulating paraprotein&#46; Serum protein electrophoresis &#40;SPE&#41; is the most commonly used technique for measuring monoclonal bands&#44; but its sensitivity is limited&#58; it is incapable of detecting MP at concentrations &#60;400mg&#47;l&#44; levels that are frequently observed in cases of Bence-Jones &#40;BJ&#41; or light chain multiple myeloma &#40;BJMM&#41;&#46;<span class="elsevierStyleSup">2 </span>Immunofixation electrophoresis &#40;IFE&#41; is a more sensitive technique for characterising the type of MP but not to quantify it&#44; and therefore it is of limited application during the MG follow-up&#46; Both urine electrophoresis and immunofixation are more sensitive than their equivalents in serum samples<span class="elsevierStyleSup">1&#44;4</span>&#59; however&#44; they are affected by the renal function of the patient&#44; which is their primary disadvantage &#40;Figure 1&#41;&#46; Nephelometric techniques are the most precise and sensitive analytical methods available&#44; but they do not make the distinction between monoclonal and polyclonal backgroud&#46; A recent addition to the last techniques has been the sFLC assay&#44; which allows for measuring sFLC and determining monoclonality by establishing the ratio of &#954;vs &#955;sFLC&#46;<span class="elsevierStyleSup">2 </span>This assay allows the detection of &#954;FLC and &#955;FLC separately using polyclonal antibodies produced in sheep that specifically recognise epitopes in the constant region of LC that are hidden in intact immunoglobulins&#44; but are exposed in sFLC&#46;<span class="elsevierStyleSup">1 </span>The sFLC assay is the most sensitive assessment technique currently available&#46; However&#44; no technique can provide by itself a diagnosis of the various types of MG&#44; and so they must be used together in order to provide a high sensitivity in the diagnosis&#46;<span class="elsevierStyleSup">5 </span></p><p class="elsevierStylePara">For the first time&#44; sFLC assay allowed for measuring normal serum levels and determining a reference range for normal subjects&#46; The normal range of &#954;FLC is 3&#46;3-19&#46;4mg&#47;l&#44; and the normal range for &#955;FLC is 5&#46;7-26&#46;3mg&#47;l&#44; with a normal interval for the &#954;&#47;&#955;sFLC of 0&#46;26-1&#46;65&#46;<span class="elsevierStyleSup">6 </span>Using this range in a retrospective study&#44; Bradwell demonstrated that 100&#37; of patients with BJMM have an altered &#954;&#47;&#955;ratio&#44; suggesting monoclonality&#46;<span class="elsevierStyleSup">7 </span>In the field of MG&#44; sFLC assay has shown a greater sensitivity for detecting the monoclonal component&#44; with special relevance in non-secretory MM&#44; in which it is now possible to measure and monitor MP without having to recurre to invasive techniques&#44; and in the case of AL amyloidosis&#44; where international guidelines recommend measuring sFLC as part of the diagnostic process&#46;<span class="elsevierStyleSup">8&#44;9 </span>Additionally&#44; measuring sFLC at the moment of diagnosing MM and other MG takes on a role in prognosis and will provide a valuable baseline value for monitoring the patient during treatment&#46;<span class="elsevierStyleSup">8&#44;10 </span>Recently&#44; Katzmann performed a study with 1877 patients with MG&#44; showing that a higher sensitivity for diagnosis could be achieved for the majority of malignant MG using a protocol of serum analyses &#40;SPE &#43; sFLC &#43; sIFE&#41;&#46; Based on their results&#44; these authors proposed replacing IFE in 24-hour urine samples with the sFLC assay&#46;<span class="elsevierStyleSup">11 </span>This simple algorithm allows for orientating the diagnosis towards cast nephropathy &#40;Figure 2&#41;&#46; In a similar manner&#44; the International Myeloma Working Group recommended using a combination of SPE&#44; sFLC&#44; and sIFE for tracking MG&#44; and suggested that the sFLC assay could substitute IFE in 24-hour urine samples&#46; This last test&#44; however&#44; still remains necessary in the case of strong&#44; unconfirmed suspicion of AL amyloidosis&#46;<span class="elsevierStyleSup">8 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RENAL FAILURE AND THE NEW RANGE OF NORMALITY FOR PATIENTS WITH A PRIOR ABNORMAL RENAL FUNCTION </span></p><p class="elsevierStylePara">One important consideration for clinical practice is that the renal failure itself affects sFLC levels due to the reduced filtration rate&#46; However&#44; the sFLC assay has shown that&#44; in the majority of cases of renal failure not derived from MG&#44; the sFLC coefficient remains within its normal range&#46; Some patients with renal failure have values that fall just outside of the normal range&#46; This abnormal value in the &#954;&#47;&#955;coefficient is proportional to the progression of the renal disease&#44; and can pose a challenge when diagnosing patients with renal failure prior to MG&#46;<span class="elsevierStyleSup">12&#44;13 </span>In order to avoid this issue&#44; Hutchison measured &#954; and &#955; sFLC in 688 patients with renal failure and no MG&#44; establishing a new range of normality for patients with renal failure at 0&#46;37-3&#46;1&#46;<span class="elsevierStyleSup">12&#44;13 </span>The new &#8220;renal range&#8221; has been validated&#44; and maintains a sensitivity of 100&#37;&#44; improving the specificity for the assay in cases of renal failure from 93&#37; to 99&#37;&#46;<span class="elsevierStyleSup">13&#44;14 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">NEPHROTOXIC PROPERTIES OF SERUM FREE LIGHT CHAINS </span></p><p class="elsevierStylePara">MG are frequently associated with renal disease&#44; and up to 50&#37; of patients with MM already have altered renal function at the time of diagnosis &#40;10&#37;-20&#37; dependent on dialysis&#41;&#46;<span class="elsevierStyleSup">15&#44;16 </span>The nephrotoxic properties of sFLC are well known&#44; and are attributed with the increased risk of suffering renal damage in patients with MG&#46; Their toxicity can develop at different levels&#58; 1&#41; glomerular&#58; formation of amyloid fibrils&#44; usually &#955;sFLC&#44; or deposits in the basal membrane associated with &#954;sFLC&#59; 2&#41; proximal tubule&#58; the exacerbated process of reabsorption stimulates the production of cytokines and&#44; consequently&#44; the inflammatory response and fibrosis produced can lead to acute tubular necrosis&#59; or&#44; even&#44; by the incapacity of cells to degrade FLC that accumulate intracellularly&#44; forming crystals characteristic of Fanconi syndrome<span class="elsevierStyleSup">17</span>&#59; 3&#41; the distal tubule&#58; once the absorption capacity of the proximal tubule is surpassed&#44; the FLC precipitate with Tamm-Horsfall proteins&#44; causing cast nephropathy with the formation of waxy casts that eventually block the nephron and produce renal failure &#40;Figure 1&#41;&#46; Cast nephropathy&#44; or &#8220;myeloma kidney&#44;&#8221; is the most commonly seen nephropathy in MM&#46; This condition is irreversible as long as the tumour remains active&#44; and is associated with a worse prognosis&#44; making effective tools for an early diagnosis essential&#44; so as to detect MG before the appearance of this renal lesions&#46;<span class="elsevierStyleSup">18 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">IMPACT OF AN EARLY DIAGNOSIS </span></p><p class="elsevierStylePara">The amount of time elapsed before a diagnosis is established and treatment is started is very important&#46; A prolonged time until MM is diagnosed increases the probability of complications&#44; among which stands out renal lesions&#46;<span class="elsevierStyleSup">19&#44;20 </span>The nephrologist plays a central role in the early diagnosis of the disease as a substantial portion of patients develop acute renal failure without known MG&#46;<span class="elsevierStyleSup">21 </span>Particularly in relation to myeloma kidney&#44; 50&#37; of patients will seek treatment in the nephrology department&#44; 100&#37; of which are identifiable using sFLC assays&#46;<span class="elsevierStyleSup">13&#44;22 </span>Recent studies have shown that a rapid decrease in sFLC allows for a greater rate of renal recovery&#46; This is due to the progression of the disease towards interstitial fibrosis&#44; which results in irreversible renal damage&#46;<span class="elsevierStyleSup">20 </span>Once more&#44; the delay before clinical intervention will determine the prognosis&#44; since 80&#37; of patients require a reduction in sFLC &#62;60&#37; by day 21 in order to reach renal recovery&#44; and this renal recovery entails a significant improvement in survival&#46;<span class="elsevierStyleSup">23 </span></p><p class="elsevierStylePara">A rapid diagnosis and start of treatment are possible through good interaction between nephrologists&#44; haematologists&#44; and oncologists&#44; leading to improved survival&#46; Given the high sensitivity of the test&#44; sFLC measurement allows for a rapid identification of nephrotoxic monoclonal proteins in patients with acute renal failure&#46;<span class="elsevierStyleSup">23 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MONITORING TREATMENT </span></p><p class="elsevierStylePara">In addition to providing a tool for the early diagnosis of MG&#44; sFLC assay plays an important role in monitoring the elimination of sFLC in patients with MG&#46; The strategy for treating MM is based on the application of chemotherapy to eliminate the malignant PC clone&#44; and at the same time&#44; direct elimination of the circulating sFLC in the bloodstream&#46; </p><p class="elsevierStylePara">The treatment of MM has evolved substantially in recent years due to the development of more effective and faster drugs&#44; such as thalidomide&#44; lenalidomide&#44; and bortezomib&#44; with higher response rates and better long-term results&#46; Bortezomib is approved by the FDA&#44; is well-tolerated by patients with renal failure&#44; and its pharmacokinetics is not affected by the level of renal failure&#44; so it can be administered with no need for readjusting the dose&#46; Bortezomib with dexamethasone is the recommended treatment for patients with MM and renal failure of any level&#46;<span class="elsevierStyleSup">24 </span></p><p class="elsevierStylePara">Plasmapheresis has not shown to be as effective as expected for eliminating sFLC&#46;<span class="elsevierStyleSup">25&#44;26 </span>The fact that a large part of the circulating sFLC are located in the extravascular space&#44; along with limits to the duration and frequency of plasmapheresis cycles&#44; may be the basis for the lack of effectiveness observed with this treatment&#46; However&#44; the studies performed until now have supported the relationship between a reduction in sFLC levels and renal recovery&#46;<span class="elsevierStyleSup">21&#44;26 </span>More recently&#44; different haemodialysis filters have been developed with a high cut-off point &#40;HCO&#41;&#44; which allows for the passage of sFLC without an excessive loss of albumin&#46;<span class="elsevierStyleSup">16&#44;27 </span>The HCO 1100 membrane has demonstrated its high effectiveness that&#44; in combination with proper chemotherapy&#44; produces promising results for the recovery of patients with myeloma kidney&#46;<span class="elsevierStyleSup">28&#44;29 </span>A swift and constant decrease in sFLC was associated with recovery of the kidney in 74&#37; of patients in the study by Hutchison&#44;<span class="elsevierStyleSup">28 </span>and 50&#37; in the study published by Martin-Reyes<span class="elsevierStyleSup">29 </span>in this same issue of Nefrolog&#237;a&#46; Given the short half-life of sFLC in comparison to intact immunoglobulins&#44; measuring sFLC allows for determining levels before and after each cycle of haemodialysis almost in real time&#46;<span class="elsevierStyleSup">29 </span>In this manner&#44; measuring sFLC is important in monitoring the treatment of these patients because it allows us to&#58; 1&#41; evaluate the efficient elimination of sFLC during dialysis&#59; 2&#41; analyse the efficiency of chemotherapy during treatment&#44; with the option of adjusting the treatment regimen as needed&#59; 3&#41; determine the moment in which the patient has recovered renal function&#44; starting to metabolise the sFLC anew&#59; and 4&#41; early diagnosis of recurrence&#46; </p><p class="elsevierStylePara">Each year&#44; the incidence of MM increases&#44; but we have the possibility of providing more effective treatment to these patients&#46; This is due to the development of more effective new-generation chemotherapies&#44; in addition to the possibility of offering a rapid decrease in circulating sFLC&#44; thus reducing the probability of irreversible renal damage&#44; which reduces survival&#46;<span class="elsevierStyleSup">30 </span>As such&#44; this is an important time of great advancements and expectations in the treatment of MM and the recovery of these patients&#44; in which the clinician still plays an important role in providing attentive care and quick action&#46; However&#44; no therapy provides effective results after a late diagnosis&#44; and the major advantage that we have today is a simple protocol that allows us to identify patients with clinically relevant MG efficiently and earlier&#46; </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara">The authors M&#46; Luisa Campos and Nuno M&#46; Barbosa de Carvalho work for Binding Site Spain&#46; </p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11098&#95;16025&#95;25688&#95;en&#95;f1&#95;11098&#46;jpg" class="elsevierStyleCrossRefs"><img src="11098_16025_25688_en_f1_11098.jpg" alt="Free light chains and the kidney"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Free light chains and the kidney</p><p class="elsevierStylePara"><a href="grande&#47;11098&#95;16025&#95;25689&#95;en&#95;f2&#95;11098&#46;jpg" class="elsevierStyleCrossRefs"><img src="11098_16025_25689_en_f2_11098.jpg" alt="Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy</p>"
    "pdfFichero" => "P1-E532-S3380-A11098-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25688_en_f1_11098.jpg"
            "Alto" => 1311
            "Ancho" => 2089
            "Tamanyo" => 1893534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Free light chains and the kidney"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25689_en_f2_11098.jpg"
            "Alto" => 993
            "Ancho" => 2083
            "Tamanyo" => 1076778
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR. Serum Free Light Chain Analysis (plus Hevylite). 6.ª ed. 2010."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR, Carr-Smith HD, Mead GP, Tang LX, Showell PJ, Drayson MT, et al. Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem 2001;47(4):673-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11274017" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Keren DF. Procedures for the evaluation of monoclonal immunoglobulins. Arch Pathol Lab Med 1999;123(2):126-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10050785" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Basnayake K, Cockwell P. Serum free light chain assessment in monoclonal gammopathy and kidney disease. Nat Rev Nephrol 2009;5(11):621-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19786994" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev 2009;30(3):105-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19841692" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA, Clark RJ, Abraham RS, Bryant S, Lymp JF, Bradwell AR, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 2002;48(9):1437-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12194920" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR, Carr-Smith HD, Mead GP, Harvey TC, Drayson MT. Serum test for assessment of patients with Bence Jones myeloma. Lancet 2003;361(9356):489-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12583950" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R, et al.\u{A0}International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23(2):215-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19020545" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López-Corral L, García-Sanz R, San Miguel JF. [Value of serum free light chains assay in plasma cell disorders]. Med Clin (Barc) 2010;135(8):368-74."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kyle RA, Durie BGM, Rajkumar SV, Landgren O, Blade J, Merlini G, et al.\u{A0}Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010;24(6):1121-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20410922" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA, Dispenzieri A, Kyle RA, Snyder MR, Plevak MF, Larson DR, et al.\u{A0}Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc 2006;81(12):1575-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17165636" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Harding S, Hewins P, Mead GP, Townsend J, Bradwell AR, et al. Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3(6):1684-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18945993" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Plant T, Drayson M, Cockwell P, Kountouri M, Basnayake K, et al.\u{A0}Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrol 2008;9:11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18808676" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis? Am J Clin Pathol 2009;131(2):166-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19141376" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bladé J, Fernández-Llama P, Bosch F, Montolíu J, Lens XM, Montoto S, et al.\u{A0}Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 1998;158(17):1889-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9759684" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Cockwell P, Reid S, Chandler K, Mead GP, Harrison J, et al.\u{A0}Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies. J Am Soc Nephrol 2007;18(3):886-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17229909" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reyes GM, González IG, Alférez MJ, González JMM, Frutos MA. Cristales intracitoplasmáticos y síndrome de Fanconi en un paciente con mieloma IgA Kappa. Nefrologia 2001;XXI(2):213-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Herrera GA, Joseph L, Gu X, Hough A, Barlogie B. Renal pathologic spectrum in an autopsy series of patients with plasma cell dyscrasia. Arch Pathol Lab Med 2004;128(8):875-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15270616" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007;100(10):635-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17846059" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Basnayake K, Cheung CK, Sheaff M, Fuggle W, Kamel D, Nakoinz S, et al.\u{A0}Differential progression of renal scarring and determinants of late renal recovery in sustained dialysis dependent acute kidney injury secondary to myeloma kidney. J Clin Pathol 2010;63(10):884-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20876319" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cockwell P, Hutchison CA. Management options for cast nephropathy in multiple myeloma. Curr Opin Nephrol Hypertens 2010;19(6):550-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20827195" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Bridoux F. Renal impairment in multiple myeloma: time is of the essence. J Clin Oncol 2011;29(11):e312-313; author reply e314."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Cockwell P, Stringer S, Bradwell A, Cook M, Gertz MA, et al.\u{A0}Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J Am Soc Nephrol 2011;22(6):1129-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21511832" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dimopoulos MA, Terpos E, Chanan-Khan A, Leung N, Ludwig H, Jagannath S, et al.\u{A0}Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol 2010;28(33):4976-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20956629" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Clark WF, Stewart AK, Rock GA, Sternbach M, Sutton DM, Barrett BJ, et al.\u{A0}Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 2005;143(11):777-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16330788" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Leung N, Gertz MA, Zeldenrust SR, Rajkumar SV, Dispenzieri A, Fervenza FC, et al.\u{A0}Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains. Kidney Int 2008;73(11):1282-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18385667" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ward RA. Protein-leaking membranes for hemodialysis: a new class of membranes in search of an application? J Am Soc Nephrol 2005;16(8):2421-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15975998" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Bradwell AR, Cook M, Basnayake K, Basu S, Harding S, et al.\u{A0}Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis. Clin J Am Soc Nephrol 2009;4(4):745-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19339414" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martín-Reyes G, Toledo R, Torres A, et al. Tratamiento con hemodiálisis del fracaso renal agudo en el mieloma múltiple con filtros de alto poro.\u{A0} Nefrologia 2012;32(1):35-43."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reyes GM, Valera A, Frutos MA, Ramos B, Ordónez V, Novales EL. Supervivencia de pacientes con mieloma tratados con diálisis. Nefrologia 2003;XXIII(2):131-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000601/v0_201502091620/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000001/v0_201502091620/X2013251412000601/v0_201502091620/en/P1-E532-S3380-A11098-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000601?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

The value of serum free light chain assay in patients with monoclonal gammopathies and renal failure
Valor del ensayo de las cadenas ligeras libres en suero para los pacientes de gammapatías monoclonales e insuficiencia renal
M. Luisa Camposa, Nuno M. Barbosa-de Carvalhoa, Guillermo Martín-Reyesb
a The Binding Site Spain, Barcelona,
b Hospital Regional Universitario Carlos Haya, Málaga,
Read
17277
Times
was read the article
3504
Total PDF
13773
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251412000601"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
  "estado" => "S300"
  "fechaPublicacion" => "2012-01-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:15-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9531
    "formatos" => array:3 [
      "EPUB" => 309
      "HTML" => 8324
      "PDF" => 898
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512000604"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
      "estado" => "S300"
      "fechaPublicacion" => "2012-01-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:15-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 21483
        "formatos" => array:3 [
          "EPUB" => 309
          "HTML" => 20046
          "PDF" => 1128
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Valor del ensayo de las cadenas ligeras libres en suero para los pacientes de gammapat&#237;as monoclonales e insuficiencia renal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "15"
            "paginaFinal" => "19"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The value of serum free light chain assay in patients with monoclonal gammopathies and renal failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11098_108_19760_es_11098_f1.jpg"
                "Alto" => 398
                "Ancho" => 600
                "Tamanyo" => 286192
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Cadenas ligeras libres y el ri&#241;&#243;n"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Luisa Campos, Nuno M&#46; Barbosa-de Carvalho, Guillermo Mart&#237;n-Reyes"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46; Luisa"
                "apellidos" => "Campos"
              ]
              1 => array:2 [
                "nombre" => "Nuno M&#46;"
                "apellidos" => "Barbosa-de Carvalho"
              ]
              2 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Mart&#237;n-Reyes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412000601"
          "doi" => "10.3265/Nefrologia.pre2011.Nov.11098"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000601?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000604?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000001/v0_201502091357/X0211699512000604/v0_201502091357/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412000589"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Nov.11065"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:20-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8821
      "formatos" => array:3 [
        "EPUB" => 341
        "HTML" => 7592
        "PDF" => 888
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Renal supportive care and palliative care&#58; revision and proposal in kidney replacement therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "20"
          "paginaFinal" => "27"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Cuidados de soporte renal y cuidados paliativos renales&#58; revisi&#243;n y propuesta en terapia renal sustitutiva"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11065_16025_25899_en_t1_11065.jpg"
              "Alto" => 1042
              "Ancho" => 1080
              "Tamanyo" => 1052674
            ]
          ]
          "descripcion" => array:1 [
            "en" => "The four principles of modern bioethics"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "JUAN PABLO LEIVA-SANTOS, Juan P&#46; Leiva-Santos, ROSA SANCHEZ HERNANDEZ, Rosa S&#225;nchez-Hern&#225;ndez, HELENA GARC&#205;A-LLANA, Helena Garc&#237;a-Llana, MAR&#205;A JOS&#201; FERN&#193;NDEZ-REYES, M&#46; Jos&#233; Fern&#225;ndez-Reyes, MANUEL HERAS BENITO, Manuel Heras-Benito, &#193;LVARO Molina Ordas, &#193;lvaro Molina-Ordas, ASTRID Rodr&#237;guez, Astrid Rodr&#237;guez, FERNANDO &#193;lvarez-Ude, Fernando &#193;lvarez-Ude"
          "autores" => array:16 [
            0 => array:2 [
              "nombre" => "JUAN PABLO"
              "apellidos" => "LEIVA-SANTOS"
            ]
            1 => array:2 [
              "nombre" => "Juan P&#46;"
              "apellidos" => "Leiva-Santos"
            ]
            2 => array:2 [
              "nombre" => "ROSA"
              "apellidos" => "SANCHEZ HERNANDEZ"
            ]
            3 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "S&#225;nchez-Hern&#225;ndez"
            ]
            4 => array:2 [
              "nombre" => "HELENA"
              "apellidos" => "GARC&#205;A-LLANA"
            ]
            5 => array:2 [
              "nombre" => "Helena"
              "apellidos" => "Garc&#237;a-Llana"
            ]
            6 => array:2 [
              "nombre" => "MAR&#205;A JOS&#201;"
              "apellidos" => "FERN&#193;NDEZ-REYES"
            ]
            7 => array:2 [
              "nombre" => "M&#46; Jos&#233;"
              "apellidos" => "Fern&#225;ndez-Reyes"
            ]
            8 => array:2 [
              "nombre" => "MANUEL"
              "apellidos" => "HERAS BENITO"
            ]
            9 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Heras-Benito"
            ]
            10 => array:2 [
              "nombre" => "&#193;LVARO"
              "apellidos" => "Molina Ordas"
            ]
            11 => array:2 [
              "nombre" => "&#193;lvaro"
              "apellidos" => "Molina-Ordas"
            ]
            12 => array:2 [
              "nombre" => "ASTRID"
              "apellidos" => "Rodr&#237;guez"
            ]
            13 => array:2 [
              "nombre" => "Astrid"
              "apellidos" => "Rodr&#237;guez"
            ]
            14 => array:2 [
              "nombre" => "FERNANDO"
              "apellidos" => "&#193;lvarez-Ude"
            ]
            15 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "&#193;lvarez-Ude"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512000581"
        "doi" => "10.3265/Nefrologia.pre2011.Nov.11065"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000581?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000589?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000589/v0_201502091620/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141200061X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Nov.11167"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:12-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5983
      "formatos" => array:3 [
        "EPUB" => 334
        "HTML" => 4874
        "PDF" => 775
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Longitudinal observational studies and causality"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "12"
          "paginaFinal" => "14"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudios observacionales longitudinales y causalidad"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alfonso Muriel, Domingo Hern&#225;ndez-Marrero, V&#237;ctor Abraira"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Muriel"
            ]
            1 => array:2 [
              "nombre" => "Domingo"
              "apellidos" => "Hern&#225;ndez-Marrero"
            ]
            2 => array:2 [
              "nombre" => "V&#237;ctor"
              "apellidos" => "Abraira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512000612"
        "doi" => "10.3265/Nefrologia.pre2011.Nov.11167"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000612?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200061X?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000001/v0_201502091620/X201325141200061X/v0_201502091620/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "The value of serum free light chain assay in patients with monoclonal gammopathies and renal failure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "15"
        "paginaFinal" => "19"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46; Luisa Campos, Nuno M&#46; Barbosa-de Carvalho, Guillermo Mart&#237;n-Reyes"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "M&#46; Luisa"
            "apellidos" => "Campos"
            "email" => array:1 [
              0 => "luisa&#46;campos&#64;bindingsite&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno M&#46;"
            "apellidos" => "Barbosa-de Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Guillermo"
            "apellidos" => "Mart&#237;n-Reyes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => " The Binding Site Spain, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => " Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Valor del ensayo de las cadenas ligeras libres en suero para los pacientes de gammapat&#237;as monoclonales e insuficiencia renal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25688_en_f1_11098.jpg"
            "Alto" => 1311
            "Ancho" => 2089
            "Tamanyo" => 1893534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Free light chains and the kidney"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Monoclonal gammopathies &#40;MG&#41; are blood dyscrasias that result from a neoplastic process in plasma cell &#40;PC&#41; clones&#44; and are usually associated with an elevated production of a monoclonal protein &#40;MP&#41;&#46; This paraprotein can be an intact immunoglobulin or a light chain &#40;LC&#41;&#46; The immunoglobulins are composed of an identical pair of heavy chains joined to two identical kappa &#40;&#954;&#41; or lambda &#40;&#955;&#41; LC&#46; The heavy and light chains are produced separately&#44; and are later joined and secreted into the bloodstream&#46; In order to ensure correct conformation of the immunoglobulins&#44; PC produce an excess of LC&#44; whose surplus is secreted along with the com&#173;pleted immunoglobulins&#46; In this manner&#44; 40&#37; of LC are found free in the serum&#44; not joined to heavy chains&#46;<span class="elsevierStyleSup">1 </span>These serum free light chains &#40;sFLC&#41; have a different conformation&#58; &#954;FLC present as 25kDa monomers&#44; whereas &#955;FLC form 50kDa dimers&#46; </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DIAGNOSING MONOCLONAL GAMMOPATHIES </span></p><p class="elsevierStylePara">The diagnosis of MG is based on detecting the circulating paraprotein&#46; Serum protein electrophoresis &#40;SPE&#41; is the most commonly used technique for measuring monoclonal bands&#44; but its sensitivity is limited&#58; it is incapable of detecting MP at concentrations &#60;400mg&#47;l&#44; levels that are frequently observed in cases of Bence-Jones &#40;BJ&#41; or light chain multiple myeloma &#40;BJMM&#41;&#46;<span class="elsevierStyleSup">2 </span>Immunofixation electrophoresis &#40;IFE&#41; is a more sensitive technique for characterising the type of MP but not to quantify it&#44; and therefore it is of limited application during the MG follow-up&#46; Both urine electrophoresis and immunofixation are more sensitive than their equivalents in serum samples<span class="elsevierStyleSup">1&#44;4</span>&#59; however&#44; they are affected by the renal function of the patient&#44; which is their primary disadvantage &#40;Figure 1&#41;&#46; Nephelometric techniques are the most precise and sensitive analytical methods available&#44; but they do not make the distinction between monoclonal and polyclonal backgroud&#46; A recent addition to the last techniques has been the sFLC assay&#44; which allows for measuring sFLC and determining monoclonality by establishing the ratio of &#954;vs &#955;sFLC&#46;<span class="elsevierStyleSup">2 </span>This assay allows the detection of &#954;FLC and &#955;FLC separately using polyclonal antibodies produced in sheep that specifically recognise epitopes in the constant region of LC that are hidden in intact immunoglobulins&#44; but are exposed in sFLC&#46;<span class="elsevierStyleSup">1 </span>The sFLC assay is the most sensitive assessment technique currently available&#46; However&#44; no technique can provide by itself a diagnosis of the various types of MG&#44; and so they must be used together in order to provide a high sensitivity in the diagnosis&#46;<span class="elsevierStyleSup">5 </span></p><p class="elsevierStylePara">For the first time&#44; sFLC assay allowed for measuring normal serum levels and determining a reference range for normal subjects&#46; The normal range of &#954;FLC is 3&#46;3-19&#46;4mg&#47;l&#44; and the normal range for &#955;FLC is 5&#46;7-26&#46;3mg&#47;l&#44; with a normal interval for the &#954;&#47;&#955;sFLC of 0&#46;26-1&#46;65&#46;<span class="elsevierStyleSup">6 </span>Using this range in a retrospective study&#44; Bradwell demonstrated that 100&#37; of patients with BJMM have an altered &#954;&#47;&#955;ratio&#44; suggesting monoclonality&#46;<span class="elsevierStyleSup">7 </span>In the field of MG&#44; sFLC assay has shown a greater sensitivity for detecting the monoclonal component&#44; with special relevance in non-secretory MM&#44; in which it is now possible to measure and monitor MP without having to recurre to invasive techniques&#44; and in the case of AL amyloidosis&#44; where international guidelines recommend measuring sFLC as part of the diagnostic process&#46;<span class="elsevierStyleSup">8&#44;9 </span>Additionally&#44; measuring sFLC at the moment of diagnosing MM and other MG takes on a role in prognosis and will provide a valuable baseline value for monitoring the patient during treatment&#46;<span class="elsevierStyleSup">8&#44;10 </span>Recently&#44; Katzmann performed a study with 1877 patients with MG&#44; showing that a higher sensitivity for diagnosis could be achieved for the majority of malignant MG using a protocol of serum analyses &#40;SPE &#43; sFLC &#43; sIFE&#41;&#46; Based on their results&#44; these authors proposed replacing IFE in 24-hour urine samples with the sFLC assay&#46;<span class="elsevierStyleSup">11 </span>This simple algorithm allows for orientating the diagnosis towards cast nephropathy &#40;Figure 2&#41;&#46; In a similar manner&#44; the International Myeloma Working Group recommended using a combination of SPE&#44; sFLC&#44; and sIFE for tracking MG&#44; and suggested that the sFLC assay could substitute IFE in 24-hour urine samples&#46; This last test&#44; however&#44; still remains necessary in the case of strong&#44; unconfirmed suspicion of AL amyloidosis&#46;<span class="elsevierStyleSup">8 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RENAL FAILURE AND THE NEW RANGE OF NORMALITY FOR PATIENTS WITH A PRIOR ABNORMAL RENAL FUNCTION </span></p><p class="elsevierStylePara">One important consideration for clinical practice is that the renal failure itself affects sFLC levels due to the reduced filtration rate&#46; However&#44; the sFLC assay has shown that&#44; in the majority of cases of renal failure not derived from MG&#44; the sFLC coefficient remains within its normal range&#46; Some patients with renal failure have values that fall just outside of the normal range&#46; This abnormal value in the &#954;&#47;&#955;coefficient is proportional to the progression of the renal disease&#44; and can pose a challenge when diagnosing patients with renal failure prior to MG&#46;<span class="elsevierStyleSup">12&#44;13 </span>In order to avoid this issue&#44; Hutchison measured &#954; and &#955; sFLC in 688 patients with renal failure and no MG&#44; establishing a new range of normality for patients with renal failure at 0&#46;37-3&#46;1&#46;<span class="elsevierStyleSup">12&#44;13 </span>The new &#8220;renal range&#8221; has been validated&#44; and maintains a sensitivity of 100&#37;&#44; improving the specificity for the assay in cases of renal failure from 93&#37; to 99&#37;&#46;<span class="elsevierStyleSup">13&#44;14 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">NEPHROTOXIC PROPERTIES OF SERUM FREE LIGHT CHAINS </span></p><p class="elsevierStylePara">MG are frequently associated with renal disease&#44; and up to 50&#37; of patients with MM already have altered renal function at the time of diagnosis &#40;10&#37;-20&#37; dependent on dialysis&#41;&#46;<span class="elsevierStyleSup">15&#44;16 </span>The nephrotoxic properties of sFLC are well known&#44; and are attributed with the increased risk of suffering renal damage in patients with MG&#46; Their toxicity can develop at different levels&#58; 1&#41; glomerular&#58; formation of amyloid fibrils&#44; usually &#955;sFLC&#44; or deposits in the basal membrane associated with &#954;sFLC&#59; 2&#41; proximal tubule&#58; the exacerbated process of reabsorption stimulates the production of cytokines and&#44; consequently&#44; the inflammatory response and fibrosis produced can lead to acute tubular necrosis&#59; or&#44; even&#44; by the incapacity of cells to degrade FLC that accumulate intracellularly&#44; forming crystals characteristic of Fanconi syndrome<span class="elsevierStyleSup">17</span>&#59; 3&#41; the distal tubule&#58; once the absorption capacity of the proximal tubule is surpassed&#44; the FLC precipitate with Tamm-Horsfall proteins&#44; causing cast nephropathy with the formation of waxy casts that eventually block the nephron and produce renal failure &#40;Figure 1&#41;&#46; Cast nephropathy&#44; or &#8220;myeloma kidney&#44;&#8221; is the most commonly seen nephropathy in MM&#46; This condition is irreversible as long as the tumour remains active&#44; and is associated with a worse prognosis&#44; making effective tools for an early diagnosis essential&#44; so as to detect MG before the appearance of this renal lesions&#46;<span class="elsevierStyleSup">18 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">IMPACT OF AN EARLY DIAGNOSIS </span></p><p class="elsevierStylePara">The amount of time elapsed before a diagnosis is established and treatment is started is very important&#46; A prolonged time until MM is diagnosed increases the probability of complications&#44; among which stands out renal lesions&#46;<span class="elsevierStyleSup">19&#44;20 </span>The nephrologist plays a central role in the early diagnosis of the disease as a substantial portion of patients develop acute renal failure without known MG&#46;<span class="elsevierStyleSup">21 </span>Particularly in relation to myeloma kidney&#44; 50&#37; of patients will seek treatment in the nephrology department&#44; 100&#37; of which are identifiable using sFLC assays&#46;<span class="elsevierStyleSup">13&#44;22 </span>Recent studies have shown that a rapid decrease in sFLC allows for a greater rate of renal recovery&#46; This is due to the progression of the disease towards interstitial fibrosis&#44; which results in irreversible renal damage&#46;<span class="elsevierStyleSup">20 </span>Once more&#44; the delay before clinical intervention will determine the prognosis&#44; since 80&#37; of patients require a reduction in sFLC &#62;60&#37; by day 21 in order to reach renal recovery&#44; and this renal recovery entails a significant improvement in survival&#46;<span class="elsevierStyleSup">23 </span></p><p class="elsevierStylePara">A rapid diagnosis and start of treatment are possible through good interaction between nephrologists&#44; haematologists&#44; and oncologists&#44; leading to improved survival&#46; Given the high sensitivity of the test&#44; sFLC measurement allows for a rapid identification of nephrotoxic monoclonal proteins in patients with acute renal failure&#46;<span class="elsevierStyleSup">23 </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MONITORING TREATMENT </span></p><p class="elsevierStylePara">In addition to providing a tool for the early diagnosis of MG&#44; sFLC assay plays an important role in monitoring the elimination of sFLC in patients with MG&#46; The strategy for treating MM is based on the application of chemotherapy to eliminate the malignant PC clone&#44; and at the same time&#44; direct elimination of the circulating sFLC in the bloodstream&#46; </p><p class="elsevierStylePara">The treatment of MM has evolved substantially in recent years due to the development of more effective and faster drugs&#44; such as thalidomide&#44; lenalidomide&#44; and bortezomib&#44; with higher response rates and better long-term results&#46; Bortezomib is approved by the FDA&#44; is well-tolerated by patients with renal failure&#44; and its pharmacokinetics is not affected by the level of renal failure&#44; so it can be administered with no need for readjusting the dose&#46; Bortezomib with dexamethasone is the recommended treatment for patients with MM and renal failure of any level&#46;<span class="elsevierStyleSup">24 </span></p><p class="elsevierStylePara">Plasmapheresis has not shown to be as effective as expected for eliminating sFLC&#46;<span class="elsevierStyleSup">25&#44;26 </span>The fact that a large part of the circulating sFLC are located in the extravascular space&#44; along with limits to the duration and frequency of plasmapheresis cycles&#44; may be the basis for the lack of effectiveness observed with this treatment&#46; However&#44; the studies performed until now have supported the relationship between a reduction in sFLC levels and renal recovery&#46;<span class="elsevierStyleSup">21&#44;26 </span>More recently&#44; different haemodialysis filters have been developed with a high cut-off point &#40;HCO&#41;&#44; which allows for the passage of sFLC without an excessive loss of albumin&#46;<span class="elsevierStyleSup">16&#44;27 </span>The HCO 1100 membrane has demonstrated its high effectiveness that&#44; in combination with proper chemotherapy&#44; produces promising results for the recovery of patients with myeloma kidney&#46;<span class="elsevierStyleSup">28&#44;29 </span>A swift and constant decrease in sFLC was associated with recovery of the kidney in 74&#37; of patients in the study by Hutchison&#44;<span class="elsevierStyleSup">28 </span>and 50&#37; in the study published by Martin-Reyes<span class="elsevierStyleSup">29 </span>in this same issue of Nefrolog&#237;a&#46; Given the short half-life of sFLC in comparison to intact immunoglobulins&#44; measuring sFLC allows for determining levels before and after each cycle of haemodialysis almost in real time&#46;<span class="elsevierStyleSup">29 </span>In this manner&#44; measuring sFLC is important in monitoring the treatment of these patients because it allows us to&#58; 1&#41; evaluate the efficient elimination of sFLC during dialysis&#59; 2&#41; analyse the efficiency of chemotherapy during treatment&#44; with the option of adjusting the treatment regimen as needed&#59; 3&#41; determine the moment in which the patient has recovered renal function&#44; starting to metabolise the sFLC anew&#59; and 4&#41; early diagnosis of recurrence&#46; </p><p class="elsevierStylePara">Each year&#44; the incidence of MM increases&#44; but we have the possibility of providing more effective treatment to these patients&#46; This is due to the development of more effective new-generation chemotherapies&#44; in addition to the possibility of offering a rapid decrease in circulating sFLC&#44; thus reducing the probability of irreversible renal damage&#44; which reduces survival&#46;<span class="elsevierStyleSup">30 </span>As such&#44; this is an important time of great advancements and expectations in the treatment of MM and the recovery of these patients&#44; in which the clinician still plays an important role in providing attentive care and quick action&#46; However&#44; no therapy provides effective results after a late diagnosis&#44; and the major advantage that we have today is a simple protocol that allows us to identify patients with clinically relevant MG efficiently and earlier&#46; </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara">The authors M&#46; Luisa Campos and Nuno M&#46; Barbosa de Carvalho work for Binding Site Spain&#46; </p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11098&#95;16025&#95;25688&#95;en&#95;f1&#95;11098&#46;jpg" class="elsevierStyleCrossRefs"><img src="11098_16025_25688_en_f1_11098.jpg" alt="Free light chains and the kidney"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Free light chains and the kidney</p><p class="elsevierStylePara"><a href="grande&#47;11098&#95;16025&#95;25689&#95;en&#95;f2&#95;11098&#46;jpg" class="elsevierStyleCrossRefs"><img src="11098_16025_25689_en_f2_11098.jpg" alt="Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy</p>"
    "pdfFichero" => "P1-E532-S3380-A11098-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25688_en_f1_11098.jpg"
            "Alto" => 1311
            "Ancho" => 2089
            "Tamanyo" => 1893534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Free light chains and the kidney"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11098_16025_25689_en_f2_11098.jpg"
            "Alto" => 993
            "Ancho" => 2083
            "Tamanyo" => 1076778
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Proposed protocol for the diagnosis and follow-up of acute renal failure&#47;monoclonal gammopathy"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR. Serum Free Light Chain Analysis (plus Hevylite). 6.ª ed. 2010."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR, Carr-Smith HD, Mead GP, Tang LX, Showell PJ, Drayson MT, et al. Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem 2001;47(4):673-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11274017" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Keren DF. Procedures for the evaluation of monoclonal immunoglobulins. Arch Pathol Lab Med 1999;123(2):126-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10050785" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Basnayake K, Cockwell P. Serum free light chain assessment in monoclonal gammopathy and kidney disease. Nat Rev Nephrol 2009;5(11):621-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19786994" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev 2009;30(3):105-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19841692" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA, Clark RJ, Abraham RS, Bryant S, Lymp JF, Bradwell AR, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 2002;48(9):1437-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12194920" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bradwell AR, Carr-Smith HD, Mead GP, Harvey TC, Drayson MT. Serum test for assessment of patients with Bence Jones myeloma. Lancet 2003;361(9356):489-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12583950" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R, et al.\u{A0}International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23(2):215-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19020545" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López-Corral L, García-Sanz R, San Miguel JF. [Value of serum free light chains assay in plasma cell disorders]. Med Clin (Barc) 2010;135(8):368-74."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kyle RA, Durie BGM, Rajkumar SV, Landgren O, Blade J, Merlini G, et al.\u{A0}Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010;24(6):1121-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20410922" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Katzmann JA, Dispenzieri A, Kyle RA, Snyder MR, Plevak MF, Larson DR, et al.\u{A0}Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc 2006;81(12):1575-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17165636" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Harding S, Hewins P, Mead GP, Townsend J, Bradwell AR, et al. Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3(6):1684-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18945993" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Plant T, Drayson M, Cockwell P, Kountouri M, Basnayake K, et al.\u{A0}Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrol 2008;9:11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18808676" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis? Am J Clin Pathol 2009;131(2):166-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19141376" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bladé J, Fernández-Llama P, Bosch F, Montolíu J, Lens XM, Montoto S, et al.\u{A0}Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 1998;158(17):1889-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9759684" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Cockwell P, Reid S, Chandler K, Mead GP, Harrison J, et al.\u{A0}Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies. J Am Soc Nephrol 2007;18(3):886-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17229909" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reyes GM, González IG, Alférez MJ, González JMM, Frutos MA. Cristales intracitoplasmáticos y síndrome de Fanconi en un paciente con mieloma IgA Kappa. Nefrologia 2001;XXI(2):213-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Herrera GA, Joseph L, Gu X, Hough A, Barlogie B. Renal pathologic spectrum in an autopsy series of patients with plasma cell dyscrasia. Arch Pathol Lab Med 2004;128(8):875-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15270616" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007;100(10):635-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17846059" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Basnayake K, Cheung CK, Sheaff M, Fuggle W, Kamel D, Nakoinz S, et al.\u{A0}Differential progression of renal scarring and determinants of late renal recovery in sustained dialysis dependent acute kidney injury secondary to myeloma kidney. J Clin Pathol 2010;63(10):884-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20876319" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cockwell P, Hutchison CA. Management options for cast nephropathy in multiple myeloma. Curr Opin Nephrol Hypertens 2010;19(6):550-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20827195" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Bridoux F. Renal impairment in multiple myeloma: time is of the essence. J Clin Oncol 2011;29(11):e312-313; author reply e314."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Cockwell P, Stringer S, Bradwell A, Cook M, Gertz MA, et al.\u{A0}Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J Am Soc Nephrol 2011;22(6):1129-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21511832" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dimopoulos MA, Terpos E, Chanan-Khan A, Leung N, Ludwig H, Jagannath S, et al.\u{A0}Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol 2010;28(33):4976-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20956629" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Clark WF, Stewart AK, Rock GA, Sternbach M, Sutton DM, Barrett BJ, et al.\u{A0}Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 2005;143(11):777-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16330788" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Leung N, Gertz MA, Zeldenrust SR, Rajkumar SV, Dispenzieri A, Fervenza FC, et al.\u{A0}Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains. Kidney Int 2008;73(11):1282-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18385667" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ward RA. Protein-leaking membranes for hemodialysis: a new class of membranes in search of an application? J Am Soc Nephrol 2005;16(8):2421-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15975998" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hutchison CA, Bradwell AR, Cook M, Basnayake K, Basu S, Harding S, et al.\u{A0}Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis. Clin J Am Soc Nephrol 2009;4(4):745-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19339414" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martín-Reyes G, Toledo R, Torres A, et al. Tratamiento con hemodiálisis del fracaso renal agudo en el mieloma múltiple con filtros de alto poro.\u{A0} Nefrologia 2012;32(1):35-43."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reyes GM, Valera A, Frutos MA, Ramos B, Ordónez V, Novales EL. Supervivencia de pacientes con mieloma tratados con diálisis. Nefrologia 2003;XXIII(2):131-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000601/v0_201502091620/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000001/v0_201502091620/X2013251412000601/v0_201502091620/en/P1-E532-S3380-A11098-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000601?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 4 9
2024 October 62 70 132
2024 September 126 65 191
2024 August 102 110 212
2024 July 60 60 120
2024 June 94 44 138
2024 May 104 52 156
2024 April 90 33 123
2024 March 69 41 110
2024 February 74 42 116
2024 January 74 55 129
2023 December 64 33 97
2023 November 70 45 115
2023 October 63 48 111
2023 September 86 41 127
2023 August 60 36 96
2023 July 73 55 128
2023 June 105 52 157
2023 May 93 51 144
2023 April 70 43 113
2023 March 67 34 101
2023 February 50 36 86
2023 January 73 48 121
2022 December 88 56 144
2022 November 70 53 123
2022 October 72 61 133
2022 September 104 40 144
2022 August 97 66 163
2022 July 90 53 143
2022 June 70 62 132
2022 May 82 41 123
2022 April 94 77 171
2022 March 107 68 175
2022 February 98 58 156
2022 January 91 35 126
2021 December 92 49 141
2021 November 103 50 153
2021 October 90 58 148
2021 September 78 44 122
2021 August 95 52 147
2021 July 84 37 121
2021 June 143 57 200
2021 May 153 44 197
2021 April 322 98 420
2021 March 190 40 230
2021 February 177 28 205
2021 January 108 33 141
2020 December 73 17 90
2020 November 90 22 112
2020 October 73 23 96
2020 September 81 8 89
2020 August 100 36 136
2020 July 89 15 104
2020 June 79 22 101
2020 May 137 30 167
2020 April 106 30 136
2020 March 125 23 148
2020 February 141 39 180
2020 January 127 31 158
2019 December 176 46 222
2019 November 166 33 199
2019 October 171 30 201
2019 September 172 33 205
2019 August 167 10 177
2019 July 208 38 246
2019 June 149 25 174
2019 May 157 31 188
2019 April 166 37 203
2019 March 94 26 120
2019 February 60 17 77
2019 January 97 23 120
2018 December 248 53 301
2018 November 214 19 233
2018 October 175 24 199
2018 September 292 18 310
2018 August 158 18 176
2018 July 142 23 165
2018 June 112 20 132
2018 May 88 18 106
2018 April 122 13 135
2018 March 136 9 145
2018 February 90 10 100
2018 January 125 9 134
2017 December 112 12 124
2017 November 90 19 109
2017 October 83 10 93
2017 September 83 18 101
2017 August 65 16 81
2017 July 74 20 94
2017 June 89 21 110
2017 May 109 14 123
2017 April 68 15 83
2017 March 117 11 128
2017 February 137 9 146
2017 January 81 16 97
2016 December 104 11 115
2016 November 148 10 158
2016 October 201 13 214
2016 September 357 15 372
2016 August 384 24 408
2016 July 226 13 239
2016 June 204 0 204
2016 May 195 0 195
2016 April 155 0 155
2016 March 149 0 149
2016 February 150 0 150
2016 January 160 0 160
2015 December 173 0 173
2015 November 136 0 136
2015 October 117 0 117
2015 September 95 0 95
2015 August 110 0 110
2015 July 109 0 109
2015 June 62 0 62
2015 May 82 0 82
2015 April 10 0 10
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?