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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Kidney impairment is the main direct cause of early mortality along with infection in multiple myeloma (MM) patients. Although renal biopsy is not recommended when diagnosis of myeloma cast nephropathy seems certain, we emphasize that renal biopsy in MM is not only a diagnostic tool but also a prognostic determinant that can meaningfully guide therapeutic decisions in onconephrological practices.
39-year-old female was referred to oncology center from internal medicine department where she was admitted for progressive dyspnea, discovered to have AKI with serum creatinine 14 mg/dl, normocytic normochromic anemia at Hgb 7.8 g/dl. The patient underwent HD and renal biopsy was done. Biopsy showed myeloma cast nephropathy. The patient was referred to oncology center on maintenance HD. At diagnosis, bone marrow had plasma cells 36%, scattered ill-defined small osteolytic lesions. SPEP showed monoclonal band at gamma region with clonality at heavy chain IgG and light chain Kappa. She started chemotherapy with cyclophosphamide, bortezomib, dexamethasone, and follow up showed complete remission.
The patient referred to onconephrology clinic for evaluation as a candidate for HSCTx. She was stable, independent from dialysis, stable serum creatinine at 3.6 mg/dl with eGFR 18 ml/min/1.73 m2 by (CKD-EPI), no contraindication for HSCTx from nephrological aspect. The HSCTx team was worried from the renal point of view, and the patient was to be excluded. Many worldwide oncology centers exclude MM patients with serum creatinine > 2 mg/dl.
We decided to do re-biopsy for prognosis and whether the kidney would benefit from HSCTx or not to rationalize our decision. The biopsy showed MPGN pattern with only 2 sclerotic glomeruli, IF 40%. Although the element of chronicity, kidney is hopeful. So, through discussion with HSCTx team based on the favorable biopsy results and evidence from literature, the patient underwent autologous HSCTx with stable serum creatinine and eGFR through and after HSCTx.
Since then, the practice changed in oncology center; a portable HD unit at HSCTx isolation ward is being prepared for similar cases.
Autologous HSCTx remains standard of care for eligible MM patients, yet its relationship with renal function is bidirectional: MM-related kidney impairment may improve post-HSCTx—even in patients initially requiring dialysis—while HSCTx carries recognized risks of AKI and CKD. We advocate an updated onconephrology model in which onconephrology should shift from reactive consultation to full-cycle oversight: early diagnosis and biopsy, CKD-EPI–based chemotherapy dosing, vigilant renal monitoring and injury management, selective prognostic biopsy, and targeted HSCTx referral to maximize kidney outcomes. There is a need for a full comprehensive section dedicated to MM in forthcoming KDIGO guidelines.
