BackgroundIntensive haemodialysis (IHD) in addition to bortezomib-based chemotherapy might be efficient to rapidly decrease serum immunoglobulin-free light chains removal in patients with multiple myeloma (MM) and to improve renal prognosis and survival.MethodsThe aim of this retrospective multi-centre study was to compare the efficacy (renal recovery rate) of IHD and of standard haemodialysis (SHD) in patients with MM and dialysis-dependent acute kidney injury (AKI), concomitantly treated with bortezomib-based chemotherapy.ResultsWe selected 41 patients with MM and dialysis-dependent AKI, most likely due to myeloma cast nephropathy (MCN), and who were treated in eight French hospitals between January 2007 and June 2011. Patients were classified in two groups according to dialysis regimen: IHD [n = 21, with a mean of 11.3 dialysis sessions all with poly(methyl methacrylate) (PMMA) membranes for 13.2 days] and SHD (n = 20 patients, mostly three times per week, 31% with PMMA membrane). The main outcome was dialysis-independence at 3 months. At 3 months, 15 patients could stop dialysis: 8 (38.1%) in the IHD and 7 (35%) in the SHD group (P = 1). Moreover, 14 (56%) of the 25 patients who did show haematological response and only one of the 16 patients who did not were dialysis-independent (P = 0.002) at 3 months.ConclusionsThe results of this retrospective study did not show any clear renal benefit of IHD in patients with MM and MCN compared with SHD. Conversely, they underline the importance of the haematological response to chemotherapy for the renal response and patient prognosis.

Background Several cases of idiopathic nephrotic syndrome (INS) relapse following the administration of COVID-19 vaccines have recently been reported, raising questions about the potential relationship between the immune response to SARS-CoV-2 vaccination and INS pathogenesis. Methods We performed a retrospective multicenter survey describing the clinical and biological characteristics of patients presenting a relapse of INS after COVID-19 vaccination, with an assessment of outcome under treatment. Results We identified 25 patients (16 men/9 women) presenting a relapse within one month of a COVID-19 vaccine injection. Glomerular disease was of childhood onset in half the patients and most patients (21/25) had received at least one immunosuppressive drug in addition to steroids for frequently relapsing or steroid-dependent NS. All patients were in a stable condition at the time of injection and 11 had no specific treatment. In 5 patients, the last relapse was reported more than five years before vaccine injection. The Pfizer-bioNTech vaccine was used in 80% of the patients. In 18 cases, INS relapse occurred after the first injection, a mean of 17.5 days after vaccination. A second injection was nevertheless administered in 14 of these patients. Five relapses occurred after administration of the second dose, and two relapses after the administration of third dose. All but one of the patients received steroids as first-line treatment, with an additional immunosuppressive agent in 9 cases. During follow-up, complete remission was achieved in 21 patients, within one month in 17 cases. Only one patient had not achieved at least partial remission after three months of follow-up. Conclusions This case series suggests that, in rare patients, COVID-19 vaccination may trigger INS relapse that is generally easy to control. These findings should encourage physicians to persuade their patients to complete the anti-COVID 19 vaccination schedule.

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