The Early Assessment Of Renal Impairment In Multiple Myeloma

Background:Renal impairment is one of the most common serious complications of multiplemyeloma (MM),10%-40%of the MM patients with impaired renal function were foundwhen they were diagnosed, Throughout the course of about25%-50%of MM patients invarying degrees of renal dysfunction. The early renal impairment of the MM caused byrenal tubular damage, and the early renal impairment caused by MM were undifferentiated.But the clinical and traditional assessment indicators of renal impairment are limited to theassessment of glomerular injury.The assessment of renal tubular injury is lack ofsensitivity and specificity. So the assessment of MM renal impairment has a significant lag.MM patients with renal impairment often have been developed involving the glomerularbeen found, an urgent need for more sensitive indicators to evaluate the MM early Renalimpairment. Here are mainly three pathological types of renal impairment. They are CastNephropathy, Monoclonal immunoglobulin deposition disease and amyloid. There aredifferences in these pathological types of renal impairment. There is no effectivenon-invasive method to identify, except renal biopsy puncture. It brings great distress tothe clinical diagnosis and treatment. Previous studies have shown that the urinary Cys-C,urinary NGAL and urinary RBP can reflect the renal tubular injury, the serum Cys-C is themore sensitive indicator to the evaluation of glomerular function of mild damage. Theeffect of these indicators in the MM renal impairment assessment is not clear. Wespeculate that these indicators of early assessment and may have some value to distinguishbetween the various type of renal pathology in MM renal impairment. This study includedthe following two parts:Part I: The effect of serum Cys-C, urinary Cys-C, urinary RBP, urinaryNGAL in the early assessment of multiple myeloma with renalimpairmentObjective: To explore serum Cys-C, urinary Cys-C, urinary RBP, urinary NGALexperimental indicators in the assessment of multiple myeloma (MM) patients with earlyrenal damage impairment.Methods: Selected60healthy people subjects as healthy control group. According to theGFR,63patients with MM were divided into AB two groups, group A of GFR normal group, MM patients were detected by the experimental parameters and Scr, and MAU,urinaryα1-microglobulin and other conventional indicators. Selected MM patients whoseexperimental index exception take renal biopsy,observe the characteristics to reflect theMM patients with early renal impairment and in various pathological types. all data takenormality tests, non-normal measurement data, the median and range.Multiple sets ofsamples were analyzed using Kruskal-Wallis H test. Two sets of samples were analyzedusing the Wilcoxon test, P <0.05was considered statistically significant differencebetween the two samples.Results: Four experimental index of60healthy controls showed a normal distribution.Serum Cys-C, urinary Cys-C, urinary RBP, urinary NGAL medical reference range arerespectively defining(0.46,1.04)mg/L,(70,149)μg/L,(0.20,0.70)mg/L,(6.3,20.9) μg/L.Serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL of group A are non-normaldistribution.Compared with healthy controls, the serum Cys-C, urinary RBP, urinaryCys-C, urinary NGAL were significantly higher than that of healthy controls (1.04mg/L vs0.74mg/L),(1.53mg/Lvs0.46mg/L),(223μg/L vs108μg/L),(56.0μg/L vs13.7μg/L)(P<0.05).The serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL positive rateswere29.4%,79.4%,70.6%,52.9%, higher than the healthy controls.Six patients of groupA received renal biopsy after detected, and varying degrees of renal damage werediscovered. The serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL positive raterespective were66.7%,66.7%,66.7%,83.3%.Conclusion: Compared with traditional indicators, the serum Cys-C, urinary Cys-C,urinary RBP, urinary NGAL can eariler predict to assess renal impairment in patientswith MM. Part II: The characteristics of the serum Cys-C, urinary Cys-C, urinaryRBP, urinary NGAL in a variety of pathological typesObjective: To investigate the characteristics of the experimental index in differentpathological types of MM renal impairment, and try to investigate the characteristics ofthese experimental indicators with combining other traditional indicators in pathologicaltypes of MM renal impairment. Methods:1.All the MM patients whose experimental indicators are abnormal take renalbiopsy;2.Combined with the traditional indicators,observe the changes of experimentalindicators and indicators of renal damage in various pathological types.3. Statisticalanalysis: All data analysis applications SPSS18.0software. Multiple sets of samples wereanalyzed using Kruskal-Wallis H test. Two sets of samples were analyzed using theWilcoxon test, P <0.05was considered statistically significant difference between the twosamples.Results:Twenty-four cases in total received renal biopsy after abnormal results wereshown, six of them turn out to be amyloidosis, twelve cast nephropathy and6immunoglobulin deposition disease (MIDD). all the6cases of amyloidosis showedabnormal MAU results, and MAU value were significantly higher than that of healthycontrol group.In CN group,urinary Cys-C,α1-MG and urinary NGAL positive rates are100%, serum Cys-C positive rate is91.7%, MAU positive rates are75%,urinary RBPpositive rates are66.7%. All of these are higher than healthy controls (P<0.001).Compared with MIDD and amyloidosis, the urinary Cys-C and NGAL are significantlyhigher (P<0.05). In amyloidosis group, urinary RBP and MAU positive rates both are100%, the serum Cys-C positive rate is66.7%,urinary Cys-C and α1-MG positive rate are50%, urinary NGAL positive rate is33.3%.The urinary RBP, MAU, Cys-C,α1-MG andserum Cys-C are higher than healthy controls (P<0.001).Compared with MIDD and CN,the MAU is significantly higher (P=0.006). In MIDD group,the serum Cys-C positive rateis100%, the urinary RBP, MAU and α1-MG positive rate are83.3%,urinary NGALpositive rate is67.7%.The urinary RBP, MAU, Cys-C,α1-MG and serum Cys-C are higherthan healthy controls (P<0.001).Compared with CN amyloidosis, urinary RBP issignificantly higher (P=0.043).Conclusion: The MAU is higher in amyloid, the urinary Cys-C, urinary NGAL aresignificantly elevated in CN, the urinary RBP is significantly elevated in MIDD.