Single-center Clinical Study Of Multiple Myeloma Renal Damage

Objective Multiple myeloma(MM)is a clonal B-cell disease of proliferating plasma cells characterized by the production of monoclonal immunoglobulin and osteolytic lesions.The kidney is often involved.This study composes of two parts.1.To analyze clinical data,laboratory examination and follow-up of the patients first-diagnosed MM with renal injury so as to improve knowledge about the MM’s kidney damage.2.To analyze the clinical pathological features and treatment prognosis of MCN diagnosed by biopsy,and then compare MCN’s clinical features with AL’s.Pathological diagnosis is needed as early as possible for those suspected to be amyloidosis for the purpose of early and specific treatment.Methods 1.The patients first-diagnosed MM with renal injury hospitalized at Peking Union Medical College Hospital(PUMCH)from July 2012 to November 2016 were enrolled in this retrospective study.Spearman correlation models were used to analyze the association between eGFR and the potential parameters.The changes of renal function were compared betweeen the bortezomib group and the non-bortezomib group.At the same time,the effect of blood purification on the renal outcome of MM combined with severe renal injury was analyzed.2.The data about clinical manifestation,pathology,treatment and follow-up of the patients pathologically diagnosed MCN were reviewed.The hematologic and renal assessment were also recorded.Comparison about the baseline data was made with pathologically diagnosed MM-AL.Results 1.LA total of 158 cases were included.98 were male and 60 were female.The ages at diagnosis were 31～86(60.4 ±11.9)years.The Spearman correlation analysis showed that β2-microglobulin(r=-0.719,P<0.001)and lactic dehydrogenase(r=-0.199,P=0.013)negatively correlated with eGFR.After chemotherapy,the serum creatinine(Scr)and the Scr values of change in the bortezomib group were respectively not significantly different from those in the non-bortezomib group.Based on chemotherapy,the renal OR rates of MM patients with severe renal injury were significantly higher in blood purification group than those in non-blood purification group(P=0.045).2.10 cases pathologically diagnosed as MCN performed acute renal failure.The patients showed rather high rates of hematologic and renal response after treatment of bortezomib or thalidomide(62.5%and 75%respectively).The results show the kidney damage course was much shorter in MCN than in MM-AL(p=0.027).The hemoglobin levels were significantly lower in MCN than in MM-AL(p<0.001)while the serum albumin and creatine levels were much higher in the former than in the latter(p<0.001).The SPE positivity of MCN was higher than that of MM-AL(p=0.022)while the nephrotic syndrome of MCN was much less frequent than that of MM-AL(p=0.043).Conclusion 1.For patients first-diagnosed MM with renal injury,the β 2-microglobulin and lactic dehydrogenase level negatively correlated with eGFR.Chemotherapy combined with renal replacement therapy improve the renal prognosis of MM patients with serious acute kidney injury.2.MM patients with renal injury should receive chemotherapy based on bortezomib and thalidomide as early as possible.3.AL is prone to occur in MM patients performing nephrotic syndrome,mildly to middle injuried renal function as well as long kidney damage course,which are the strong indications for renal biopsy in MM.4.MCN patients performing severe AKI can improve the renal prognosis and overall suvival after chemotherapy based on bortezomib and thalidomide.