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Chapter 34: Plasma Cell Dyscrasias

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What are the most important risk factors in the development of cast nephropathy?

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A. More than 60% bone marrow plasma cells and more than one focal bone lesion on MRI

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B. Anemia and hypercalcemia

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C. Lytic bone lesions

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D. Serum free light chain level more than 50 mg/dL and a high-urinary free light chain excretion

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E. The use of non-steroidal anti-inflammatory drugs and intravenous contrast agent

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The answer is D. Both of these have been shown in large studies to predict the development of acute renal failure and cast nephropathy. A contains new definitions for symptomatic multiple myeloma but not cast nephropathy. B and C are parts of the CRAB criteria that define symptomatic multiple myeloma but not for cast nephropathy. E contains risk factors that could increase the risk of cast nephropathy but would not precipitate cast nephropathy on their own with the other risk factors.

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Which of these is the most helpful in predicting the recovery of renal function after cast nephropathy?

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A. The isotype of the immunoglobulin light chain

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B. The baseline free light chain ratio

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C. The percent reduction of the serum-free light chain

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D. The cytogenetic FISH results of the multiple myeloma

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E. The serum M-spike

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The answer is C. The recovery of renal function from cast nephropathy is predicted by the percent reduction of serum-free light chain and the speed at which that is accomplished. None of the other has been shown to have any prognostic value.

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What is the minimum level of hematologic response required to increase the chances of a renal response in AL amyloidosis?

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A. A complete response: the absence of a monoclonal protein by serum and urine immunofixation and a normal free-light chain ratio

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B. A very good partial response: dFLC less than 4 mg/dL or more than 90% reduction of the dFLC

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C. A partial response: 50% reduction of the dFLC

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D. Absent of clonal plasma cells in the bone marrow

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E. Normal serum-free light chains

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The answer is B. Studies have shown a minimum of VGPR is necessary for improvement of organ dysfunction in AL amyloidosis including the ...

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