A Study Of Clinicaland Pathological Features Of MGUS And MM And Risk Factors Of MM With Renal Impairment

Objective:To discuss the characteristics of kidney damage of monoclonal gammopathy of undetermined significance and multiple myeloma,to guide the early diagnosis;To analyze the risk factors of the patients with multiple myeloma,early prevention.Methods:Collected the clinical materials of the 14 patients with monoclonal gammopathy of undetermined significance and 225 patients with multiple myeloma in the period of 2012 to 2016.Compare with characteristics of clinical and pathological.Retrospective studied the risk factors and renal outcomes after different treatment with multiple myeloma.Results:1.In the comparison of monoclonal gammopathy of undetermined significance with the multiple myeloma,proportion of male is 57.1%、61.8%,respectively,with a mean age of whole is(54.5±6.7)years、(60.84±9.34)years.The starting clinical symptoms,as the main in monoclonal gammopathy of undetermined significance is anemia、bone-pain、edema(28.57%、21.43%、21.43%),and patients with multiple myeloma is bone-pain(59.11%),the second is anemia(16.89%).2.There is no difference to positive rate of urine protein and nrine occult blood in the two kinds of disease;to 24-hour urine protein quantity,the medium in monoclonal gammopathy of undetermined significance is 362.95mg/24 h,multiple myeloma is 1068.2mg/24h(P=0.017).3.In the clinical data of the monoclonal gammopathy of undetermined significances,the medium hemoglobin is 101.7(80.8-117.2)g/L,the serum creatinine is 74.0(57.8-115.5)μmol/L,the content of plasma cells in bone marrow is 2.5(0.5-6.0)%,the proportion of primary and immature plasma cells is 0(0-5.5)%,and the image display that the 5 patients who took bone imaging examination have on bone osteoporosis and destruction.The medium hemoglobin in patients with multiple myeloma is 76.7(65.2-90.4)g/L,serum creatinine is 97.0(75.5-222)μmol/L,the content of plasma cells in bone marrow is 31.25(16.5-50.0)%,the primary and immature plasma cells is 27.3(13.0-45.9)%,with 107 patients(52%)in multiple myeloma have bone loss and damage.The above are statistically significant.4.2 patients with monoclonal gammopathy of undetermined significance do kidney puncture biopsy pathology,the pathology showed that one is Tiny pathotype nephritis,one is membranous nephropathy.5 patients of multiple myeloma with renal puncture biopsy pathology,including 3 cases of slight change disease glomerulonephritis with varying degrees of renal tubule interstitial injury,1 case of focal segmental glomerulosclerosis with severe damage of tubulointerstitium,1 case of amyloidosis kidney disease.5.6 patients with monoclonal gammopathy of undetermined significance were enrolled in this study,4 patients with regular chemotherapy had stable renal function at the last follow-up.The renal function was lower in 2 patients without chemotherapy.6.Classification of unconditional logistic regression analysis showed that men,hemoglobin,serum calcium,primary plasma cell ratio,light chain types are the independent risk factors of multiple myeloma nephropathy.7.Treatment of multiple myeloma with renal dysfunction in the two groups of programs(including bortezomib program,the traditional program)on renal function recovery rate was no difference.Conclusion:1.Monoclonal gammopathy of undetermined significance in patients with older age than in patients with multiple myeloma.2.Patients with multiple myeloma symptoms of anemia than monoclonal immunoglobulinemia patients is more serious.3.Multiple myeloma patients with serum creatinine value than monoclonal immunoglobulin hyperthyroidism is higher,lower endogenous creatinine clearance rate.4.Male,hemoglobin,serum calcium,the ratio of primary and immature plasma cells,light chain types are multiple myeloma with renal dysfunction,independent risk factors.