Analysis Of Renal Biopsy Of 30 Cases Of Multiple Myeloma With Proteinuria Or Renal Damage As The First Manifestation

Objective:To investigate the clinical features,histopathological features,treatment and prognosis of 30 patients of MM with proteinuria or renal impairment as the first manifestation.Methods:Collected MM patients with proteinuria or renal impairment as the first manifestation who underwent renal biopsy,retrospectively analyzed their clinical features,histopathological features,treatment and prognosis.Results :(1)A total of 30 MM patients with initial presentation of proteinuria or renal impairment and renal biopsy were enrolled,with a median age of 60 years;70% of patients were stage III,43% were Ig G type,64.3% were monoclonal light chain expressing λ type.(2)MM patients with proteinuria or renal impairment as the first manifestation includes anemia,kidney impairment,bone lesions,and elevated calcium,with the incidence rates of 90%,66.67%,50%,and 3.33%,respectively.(3)MM patients with proteinuria or renal impairment as the first manifestation include MCN type,MM-AL type and LCN type accounted for63.33%,20% and 16.67%,respectively.In 50% of renal biopsy patients have light chain deposition.(4)The hemoglobin in MM-AL group was significantly higher than that in MCN group(102.07±18.58g/L VS 74.77±16.97g/L,p<0.05),the serum creatinine in MM-AL group was significantly lower than that in MCN group(89.83±59.86 umol /L VS 756.20±747.58 umol /L,p < 0.05).(5)MM patients with proteinuria or renal impairment as the first manifestation,whose plasma cell infiltration was observed in 60% of the patients’ renal tissues,mainly in the renal interstitial.(6)6 MM patients with proteinuria or renal impairment as the first manifestation,treated with bortezomid-based chemotherapy,3 patients CR,2patients VGPR,and 1 patient PR,no case CR in renal reaction.Conclusion:(1)MM patients with proteinuria or renal impairment as the first manifestation tend to be elderly,clinical stage is relatively late,the most common classification are Ig G type and λ light chain,with serious organ damage and poor prognosis.(2)The renal impairment of MM patients with the first manifestation of proteinuria or renal impairment was mainly in MCN type,while the degree of renal damage and anemia in MM-AL patients was relatively mild.(3)Light chain deposition is an important mechanism in renal impairment of MM.Plasma cell infiltration in the kidney may be another important mechanism of MM renal damage.(4)The efficacy of the bortezomib based treatment was satisfactory in MCN patients,however,renal recovery is not ideal.