Clinical Analysis Of 72 Mutiple Myeloma Patients With Renal Involvement

Objective: Clinical features of multiple myeloma (MM) patients with renal involvement were studied retrospectively, so as to improve the awareness of the disease and reduce the incidence of end stage renal disease (ESRD).Methods:Clinical features of 99 MM patients in the second affiliated hospital of Dalian Medical University during January 2002 and March 2010 were studied. The sex, age, initial symptom, misdiagnosis and routine examination, biochemistry examination, imageologic examination were analysed in the 72 patients. Two patients out of them were performed renal biopsy before MM diagnosis. The relevant factors of renal involvement about serum uric acid, hemoglobin, serum albumin, serum globulin, serum calcium and other factors were analysed with chi-square test.Results:In this group the incidence of renal involvement in MM was 72.7%. The mean age was(62.85±12.17)years. A high incidence occurred at the age from 50 to 70 years. The ratio of male to female was 1.8:1. Seventeen patients (23.6%) were misdiagnosed:4 cases as chronic renal failure,4 cases Orthopaedic diseases,3 cases Pneumonia,2 cases Chronic glomerulonephritis,1 cases acute renal failure and 1 cases nephrotic syndrome and so on. Nineteen patients died so the mortality was 26.3%(19/72). They died of infection (7 cases), multiple organ dysfuncyion syndrome (5 cases) and renal failure (3 cases). The primary symptoms of renal damage were proteinuria(88.9%) and renal insufficiency (47.1%). The treatment were aimed at the primary disease with chemotherapy. At the same time, renal preservation can be optimized by prevent dehydration, hypercalcemia, hyperuricemia and avoid infection. Elase, Five patients entered ESRD and lived with maintenance hemodialysis. By the chi-square test, we found that serum uric acid and calcium were associated obviously with renal insufficiency (P<0.01). However, hemoglobin, serum globulin and other factors had no correlation with renal insufficiency (P>0.05).Conclusions:Kidney impairment is one of the most common complications of MM and hypercalcemia, hyperuricemia were associated obviously with renal insufficiency in these patients. Renal insufficiency associated with myeloma indicates a worse prognosis, a high mortality and complicates the management of the disease. If we could find and treat the renal involvement at an early stage of MM the prognosis would be changed.