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Significance of urinary albumin excretion in patients with cast nephropathy


Ryo Nakagawa, Aya Imafuku, Eiko Hasegawa

    Clinical Nephrology
    |June 25, 2019
    PubMed
    Abstract

    Insights

    Urinary albumin excretion rate (%UAE) can help differentiate myeloma cast nephropathy (MCN) with or without glomerular amyloidosis. Lower %UAE suggests MCN without amyloid, potentially indicating a better prognosis.

    Area of Science:

    • Nephrology
    • Oncology
    • Pathology

    Background:

    • Myeloma cast nephropathy (MCN) is a kidney disease associated with multiple myeloma.
    • Distinguishing MCN with glomerular amyloid deposition from MCN without it is clinically important.
    • The role of urinary albumin excretion rate (%UAE) in this differentiation is unclear.

    Purpose of the Study:

    • To investigate if %UAE can differentiate MCN with glomerular amyloid deposition from MCN without it.
    • To assess the clinical utility of %UAE in identifying coexisting glomerular lesions in MCN.

    Main Methods:

    • Retrospective review of clinicopathological data from 16 MCN patients diagnosed via renal biopsy.
    • Patients were categorized into two groups: pure MCN (group 1) and MCN with glomerular amyloid deposition (group 2).
    • Comparison of laboratory parameters, including %UAE, serum albumin, and creatinine, between the two groups.

    Main Results:

    • Group 1 (pure MCN) had significantly higher serum albumin and lower %UAE compared to Group 2 (MCN with amyloidosis).
    • Serum creatinine was significantly higher in Group 1, while total protein and serum-adjusted calcium showed no significant differences.
    • Patients in Group 2 with multiple myeloma had a poorer survival outcome compared to those with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia.

    Conclusions:

    • Lower %UAE may indicate MCN without glomerular amyloid deposition.
    • %UAE could serve as a valuable biomarker for detecting coexisting glomerular lesions like amyloidosis in MCN patients.
    • The presence of glomerular lesions, indicated by higher %UAE, is associated with a poorer prognosis in MCN.

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