Clinical Features And Risk Factors Of Multiple Myeloma Patients With Renal Impairment

Objective:Multiple myeloma(MM)is a malignant tumor of the hematology system with abnormal proliferation of monoclonal plasma cells.In addition to hematological impairment,the renal impairment(RI)is one of its most important features.If combined with kidney damage,it seriously affects the prognosis and survival of patients.In this paper,we retrospectively analyzed the clinical features of newly diagnosed multiple myeloma cases admitted to the First Affiliated Hospital of Soochow University and analyzed the correlation between the risk factors of MM with renal damage,improved the understanding of the characteristics of MM with renal damage at the time of initial diagnosis,enhanced the level of comprehensive diagnosis and treatment of MM with renal damage by clinicians,and improved the prognosis of MM patients.Methods:Collecting the general data,clinical features and laboratory examination results of MM patients diagnosed by clinical and laboratory examinations such as immunoglobulin quantification,protein electrophoresis,bone marrow aspiration and biopsy,and cell chromosome detection from January 1,2016 to September 1,2018 in the First Affiliated Hospital of Soochow University.Comparing the differences in clinical features and laboratory examination results between MM patients with and without renal impairment,and analyze the correlation between renal function and its clinical classification,clinical stages and immune indicators.Results:1?A total of 255 cases of primary MM patients were collected,among which 65 cases with MM were associated with renal impairment,the initial age was 59.7 ± 9.1 years,with the largest distribution of patients aged 51-65 years,with various clinical symptoms,among which fatigue and back lumbar pain were more common.2?Of the 65 patients with renal impairment,28 had mild renal impairment,15 had moderate renal impairment,and 22 had severe renal impairment,with anemia in 92.3%of patients.3?Age?ISS stage?R-ISS stage?clinical manifestations(symptoms of fatigue,bone pain),hemoglobin?platelet count,blood urea nitrogen,blood uric acid,blood calcium,lactate dehydrogenase,blood?urine(32-microglobulin content,serum X free light chain quantification,urine protein,24h urinary protein quantification,bone marrow plasma cell ratio in MM patients group were significantly different compared with patients with normal renal function group(P<0.05).4?Compared with patients with normal renal function,there was no significant difference in gender,clinical classification,DS stage,serum albumin level,blood globulin level,vascular endothelial growth factor level,M protein quantification,serum kappa free light chain protein quantification,urinary lambda and kappa free light chain protein quantification,presence or absence of bone damage,flow cytometry(CD 19,CD 117,CD3 8,CD56,CD45,CD 138,CD137L,CD81,etc.),fluorescence in situ hybridization(1q21,13q14,Rbl,P53,etc.),chromosome detection and humoral immunity,such as IgG,IgM,IgA and other immunoglobulin content(P>0.05).5?Univariate regression analysis showed that age,hemoglobin,platelet,blood urea nitrogen,serum calcium,serum uric acid,lactate dehydrogenase,serum ?2-microglobulin,24-hour urinary protein quantification level and the proportion of bone marrow morphological plasma cells in MM patients were negatively correlated with the occurrence of renal damage in MM patients,while ISS stage and R-ISS stage were positively correlated with the occurrence of renal damage in MM.6?Multivariate logistic regression analysis showed that:blood urea nitrogen may be a protective factor in the reduction of renal impairment in MM patients.7?After treatment,53 patients with newly diagnosed MM and renal impairment were examined at discharge,and the average level of serum creatinine in this group of patients was 321.23 ± 213.64 ? mol/L at the initial diagnosis,and 225.76 ± 162.53 ? mol/L after treatment,with various levels of recovery of renal function in 44 patients,of which 20 patients' renal function recovered to normal levels[GFR>60ml/(min·1.73 m2)].Conclusions:1?MM renal impairment occurs in middle-aged and elderly male patients,clinical symptoms are diverse,mainly fatigue,low back pain symptoms onset,MM patients with late treatment,most of the clinical stage has been in the late.2?The correlation of ISS stage and R-ISS stage to renal impairment in MM is better than that of DS stage,which can better reflect the condition of renal damage in MM.3?Compared with patients with normal renal function,the age,ISS stage,R-ISS stage,clinical manifestations(fatigue,bone pain and other symptoms),hemoglobin,platelet count,blood urea nitrogen,blood uric acid,serum calcium,lactate dehydrogenase,blood,urine ?2-microglobulin content,blood ? free light chain quantification,urinary protein,24h urinary protein quantification,bone marrow plasma cell ratio of patients with MM with renal impairment were significantly different(P<0.05).4?Age,hemoglobin,platelet count,blood urea nitrogen,serum calcium,serum uric acid,lactate dehydrogenase,serum ?-microglobulin,24h urinary protein quantitative level and bone marrow plasma cell ratio were negatively correlated with the occurrence of renal damage in MM patients,while ISS stage and R-ISS stage were positively correlated with the occurrence of renal damage in MM.5?The increase of blood urea nitrogen may have a predictive effect on renal damage in MM patients.6?The early diagnosis and intervention of MM are important for the recovery of renal function in newly diagnosed patients with renal impairment.