Clinical Features Of 46 Multiple Myeloma Patients With Renal Pathological Changes

ObjectiveTo explore the Renal pathology, clinical features and prognosis of multiple myeloma with Renal pathological changes. And to provide some clues for clinical diagnosis and treatment of multiple myeloma with renal impairment. Methods46 MM patients who had kidney biopsy, were selected from November 2011 to February 2015 in our hospital. They were split into three groups of cast nephropathy group with 24 cases, amyloidosis group with 15 cases and other type group with 7 cases, according to renal pathology. Renal pathology, clinical features and prognosis of the three groups were retrospectively analyzed. ResultsDS stage results showed that cast nephropathy group, 0% distributed in Phase?, 29.2%(7/24) distributed in Phase?, 70.8%(17/24) distributed in Phase?, 9.1%(4/24) located in subtype A, and 90.9%(20/24) located in subtype B; amyloidosis group, 53.3%(8/15) distributed in phase I, 20%(3/24) distributed in Phase?, 26.7%(4/24) distributed in the Phase?, 60%(9/15) located in subtype A, and 40%(6/15) located in subtype B; other type group, 28.6%(2/15) distributed in phase I, 0% distributed in Phase?, 71.4%(5/7) distributed in Phase ?, 42.9%(3/7) located in subtypes A, and 57.1%(4/7) located in subtype B; The differences were statistically significant among the three groups in phases and subtypes(cast nephropathy group VS amyloid group, P<0.05; cast nephropathy group VS other type group, P<0.05). Serum IFE showed that cast nephropathy group, 75%(18/24) were not detected monoclonal immunoglobulin, which were light chain type, compared to amyloidosis group and other type group mainly were detected IgG type, respectively, 73.3%(11/15), 71.4%(5/7), the differences in them were significant(P<0.05). Cast nephropathy serum albumin was 38.8±6.1g/L, renal amyloidosis group was 21.5±3.8g/L, and other type group was 29.7±6.2g/L. pairwise comparisons among the three groups was statistically significant difference(P<0.05). 24-hour urinary protein excretion showed that cast nephropathy group was 3.3(1.3-5.0) g/d, amyloidosis 7.5(2.7-11) g/d, other type group 2.9(1.2-8.8) g/d, and there were significant differences in them(cast nephropathy group VS amyloidosis group, P<0.05). The median survival in cast nephropathy group was 11 months, amyloidosis group 19 months, other type group 18 months, The differences of the three groups were not significant(P=0.3). ConclusionMultiple myeloma patients with different renal pathology have different the clinical features. In renal pathological types, cast nephropathy was the most common, followed by amyloidosis. Serum IFE of MM cast nephropathy patients, is mostly light chain; Renal amyloidosis patients are mainly manifested as proteinuria and Hypoproteinemia. Patients with renal amyloidosis have slighter clinical manifestations and may have a better prognosis. Meanwhile, patients with renal non-amyloidosis types, especially cast nephropathy presage a more serious condition,and may have a bad prognosis.