Renal impairment in multiple myeloma: A single center experience
Imen Gorsane1, S Barbouch2, M Mayara3
1Department of Medicine A (M8); Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital; Faculty of Medicine, University of Tunis El Manar, Tunisia.
Abstract:
To determine the features of the different forms of kidney diseases associated with multiple myeloma (MM), we retrospectively studied 144 patients with kidney injury and MM at our institute from 1974 to 2014. The mean age of the patients was 60.1 years and the male:female ratio was 1.25. Renal disease was concomitant with the discovery of MM in 92% of cases. The mean follow-up of our patients was 2.1 years. Initial renal insufficiency was found in 131 (91%) patients. Cast nephropathy of the distal tubule was found in 110 (26%) patients, renal amyloidosis in 16 (11.1%), and light chain deposition disease in five (3.47%). Twelve (8.3%) patients had chronic glomerular nephropathy. Twenty-six patients reached end-stage renal failure within 13.4 months. Renal survival was 30.45 months. Predictive factors for improvement of renal function undergoing chemotherapy included serum creatinine <250 µmol/L, proteinuria <1 g/24 h, and the non-use of renal replacement therapy. Multiple pathogenic mechanisms can contribute to kidney injury in myeloma patients. Novel myeloma agents have shown considerable promise in reversing renal failure in some patients and improving outcomes.
Insights
Kidney disease is common in multiple myeloma (MM) patients, with cast nephropathy being the most frequent type. Early treatment and specific factors predict improved kidney function and survival in these patients.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Multiple myeloma (MM) frequently causes kidney disease.
- Understanding the specific kidney pathologies in MM is crucial for patient outcomes.
Purpose of the Study:
- To identify the characteristics of various kidney diseases associated with multiple myeloma.
- To analyze factors influencing renal function and survival in MM patients with kidney injury.
Main Methods:
- Retrospective study of 144 patients with kidney injury and MM (1974-2014).
- Analysis of renal biopsy findings, including cast nephropathy, amyloidosis, and light chain deposition disease.
- Evaluation of clinical data, renal function parameters, and treatment outcomes.
Main Results:
- 92% of patients had kidney disease at MM diagnosis.
- Cast nephropathy was the most common (26%), followed by renal amyloidosis (11.1%) and light chain deposition disease (3.47%).
- Predictive factors for renal function improvement included lower serum creatinine, reduced proteinuria, and avoidance of renal replacement therapy.
Conclusions:
- Multiple myeloma can lead to diverse kidney pathologies, with cast nephropathy being prevalent.
- Early detection and management of kidney injury, alongside novel therapeutic agents, are vital for improving renal outcomes in MM.
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