Clinical Analysis Of Newly Diagnosed Multiple Myeloma Patients Complicated With Renal Insufficiency

Objective:To analyze the clinical characteristics of patients with multiple myeloma(MM)and the associated risk factors for MM with renal impairment.Methods:We retrospectively analyzed the clinical data of 405 newly diagnosed multiple myeloma patients admitted to the Union Hospital of Fujian Medical University from January 1,2012 to December 31,2016.405 cases of newly diagnosed MM patients were in accordance with the diagnostic criteria of multiple myeloma,and all of them underwent bone marrow puncture,the clinical stage according to the international staging system.The definition of renal damage by definition in the KDIGO guidelines in 2012,according to the changes in serum creatinine level,which can be divided into MM with normal renal function group(A group)and MM patients with renal dysfunction group(B group)(AKI 1(B1),AKI 2(B2),AKI 3(B3)).The clinical features,laboratory tests and independent risk factors of MM combined with renal impairment in two groups were compared between the groups.Results:For 405 newly diagnosed MM patients,bone pain is the most presentation(53.3%),followed by anemia(22%),infection(4.9%),foam urine and edema(6.4%).The most common types of serum in patients with MM were type IgG(52.6%),followed by IgA type(24.4%),light chain type(18.6%),IgD type(0.25%)rare.Among the 405 newly diagnosed MM patients,42%(170/405)were renal dysfunction,of which the male accounted for 62.4%(106/170),the ratio of male to female was 1.7:1,the average age was(62±10)years,ISS III patients accounted for 49.7%.The incidence of urinary protein(1 +-3 +)and urinary erythrocyte(±,1 +-3 +)in patients with MM complicated with renal dysfunction was 75.9% and 74.7%,respectively.75 cases of newly diagnosed patients with MM serum free light chain found in renal insufficiency in the group of sFLC more than 500mg/L accounted for 55.2% of patients,and normal renal function in group sFLC more than 500mg/L patients accounted for 21.7%.Statistical analysis of MM patients FISH showed that 1q21 amplification accounted for 37.9%,IGH gene rearrangement accounted for 34.8%,RB1 deletion accounted for 34.7%,D13S319 deletion accounted for 28.9%,p53 deletion accounted for 15.6%.RB1 gene positive,1q21 gene positive and D13S319 gene positive MM patients more prone to renal dysfunction,the difference was statistically significant(P <0.05).Patients with AKI stage 3 who needed hemodialysis and long-term dialysis were significantly larger than those in other groups.Univariate analysis of variance showed that there was significant difference between renal dysfunction patients and normal renal function in serum uric acid,serum calcium,lactate dehydrogenase,hydroxybutyrate dehydrogenase,phosphorus,bone marrow plasma cell ratio,bone marrow primitive and naive plasma cell ratio,hemoglobin,age,blood β2 microglobulin,platelet count,plasma albumin,plasma IgM level,urine protein positive and erythrocyte positive rate(P <0.05).Logistic regression analysis showed that the independent risk factors of renal impairment were hemoglobin,uric acid,hypercalcemia,serum β2 Microglobulin concentration and RB1 gene deletion.conclusion:MM combined with renal insufficiency compared to renal function normal have different clinical features.Light chain type is more prone to renal insufficiency than other types.Patients with AKI stage 3 who needed hemodialysis and long-term dialysis were significantly larger than those in other groups.Hemoglobin,uric acid,hypercalcemia,serum β 2 Microglobulin concentration and RB1 gene deletion were multiple myeloma patients with renal impairment occurred independent risk factors.Patients with multiple myeloma with RB1 gene deletion are more likely to have renal impairment.