| Objective: To investigate the clinical features and outcome in renal dysfunction withnormal renal functions which patients with multiple myeloma.Methods: Collect the information with newly diagnosed MM patients hospitalizedfrom October2009to December2013, retrospectively analyzed the clinicalcharacteristics, hemoglobin, blood biochemistry, imaging, treatment, short-termeffect and the occurrence of renal damage related risk factors. Use SPSS18.0forstatistical analysis,X±S for measurement data,2examination for clinicalcharacteristics of patients of different groups, P＜0.05has statisticsignificance.Results:1. Clinical features(1) Group of normal renal function has22males and24female, the gender ratiois0.92:1; renal impairment group has29males and10females, the ratio is2.9:1.Male patients with renal impairment were significantly higher than women, and thenormal renal function has no significant group differences in the proportion of menand women.(2)46cases of patients with normal renal age39to87years old, mean age is61.15±10.50years, the mean age of the group in renal damage is65.95±11.80yearsbut the difference was not statistically significant (P=0.061). Kidney damage in70-80years old patients were more than normal renal function.(3) Normal renal function group has more anemias and fatigue, kidney damagegroup has more pain.(4) In two groups of patients, lgG and light chain proportion has higherpercentages, there was no significant difference in the MM type groups. 2. Laboratory test(1)39cases of patients with abnormal renal function,36cases (92.31%) hasanemia,46cases of patients with normal renal function,37cases (80.43%) hasanemia.(2) Renal impairment group with moderate to severe anemia, accounting for76.93%; normal renal function with mild to moderate anemia,65.22%in total.(3)85cases of MM globulin elevated (>40g/L)42cases, including39of them ofrenal impairment serum globulin has20cases (51.28%) were increase and46casesof renal function is normal serum globulin has22cases were increase (47.83%).(4)85MM patients reduced serum albumin (<35g/L) has36cases (43.35%),39cases of renal damage serum albumin has20cases were decreased (51.28%),46cases with normal renal function serum albumin has16were decreased (34.78%).(5)85MM patients with elevated lactate dehydrogenate (>245U/L) in31cases,among39cases of renal impairment group has22of them elevated lactatedehydrogenate (47.83%);46cases with normal renal function lactate dehydrogenatecatalane were increased in9cases (19.57%). Kidney damage group LDH increasedsignificantly, higher than28.26%with normal renal function group, the differenceswas statistically significant (P<0.001).(6)85cases of MM patients, serum uric acid (≥390umoL/L) has44cases(54.12%),39cases of elevated blood uric acid kidney damage group has34cases(87.18%);46cases of renal normal serum uric acid were10cases (21.74%). Theserum uric and kidney damage ratio is4.01times with normal renal function group,the difference was statistically significant (p <0.001).(7)85cases of MM patients with elevated serum calcium (>2.8mmol/L) has13cases (15.29%), among39cases of renal impairment group has11cases ofelevated blood calcium (28.21%);46cases of renal function is normal blood thereare two cases of elevated calcium (4.35%). Kidney damage group ratio of6.49foldincrease in serum calcium normal renal function group, the difference wasstatistically significant (P=0.002).(8)39cases of renal dysfunction in patients with urinary protein MM (+~+++) has 27cases, urinary protein accounting for69.23%of the same group.3. ImagingOsteoporosis is the most common of kidney damage group,25cases(64.10%);whereas normal renal function is the most common ostelytic bonedestruction,24cases (52.17%),but the two groups was statistically significant.4. Kidney damage related factorsMale, elevated serum calcium, serum uric acid renal dysfunction is a risk factor;happen age, hemoglobin, immunoglobulin type, serum globulin levels, albumin levels,lactate dehydrogenate levels and renal damage in MM has no significant correlation.5. TreatmentPatients with abnormal renal function boron overall response rate for bortezomibgroup and partial remission rate is slightly better than the thalidomide group andother groups, not bortezomib and thalidomide highest rate of complete remission,partial remission rate but poor and the differences was not significant. Patients withnormal renal function overall response rate for the same boron bortezomib group andcomplete remission rate is slightly better than the thalidomide group and othergroups; thalidomide group has the highest rate of partial remission6. DeathsSequential7deaths during the chemotherapy, the mortality rate is8.3%, thecause of death of3cases was infection,4cases was respiratory and circulatoryfailure.Conclusion1. Men prone to multiple myeloma patients with renal dysfunction.2. Elevated levels of uric acid and calcium may be the cause of multiple myelomakidney injury risk factors.3. Increases of renal dysfunction in patients with multiple bone marrow tumorlactates.4. The above conclusion is further confirmed the need to expand the number ofcases. |
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