Renal Involvement in Multiple Myeloma: an experience of a single centre

• Main Author: Santos,Clara
• Publication Date: 2013
• Other Authors: Lopes,Daniela, Barreto,Patricia, Cunha,Catia, Gomes,Ana Marta, Ventura,Ana, Coelho,Henrique, Seabra,Joaquim
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000400007
• topic: acute kidney injury; multiple myeloma; prognosis; survival analysis

Introduction: Multiple myeloma is a plasma cell dyscrasia that accounts for almost 10% of all haematologic malignancies. It often presents with acute kidney injury that has long been associated with a poor prognosis. It is important to recognize markers of poor prognosis to promote an early and aggressive management of the disease, to improve disease outcomes. Subjects and Methods: We have, therefore, investigated the clinical presentation and outcome of all 44 myelomas diagnosed in our hospital, comparing those with and without renal involvement and exploring factors associated with mortality over a 2-year period of time using the Cox regression method. Results: We found that the group of patients with renal disease (n = 18) were at higher stages of disease (stage III, 78% vs. 23%, p= 0.001), had higher percentage of plasma cells (≥ 15%, 72% vs. 38%, p = 0.027), higher values of B2-microglobulin (≥ 4.5mg/L, 83% vs. 35%, p = 0.001), lower values of haemoglobin (Hb < 9.5g/dL, 50% vs. 15%, p = 0.013) and lower values of albumin (< 3.5g/dL, 39% vs. 12%, p = 0.033). The most common type of renal involvement was cast nephropathy (44%). This group of patients had significantly lower survival at 12 and 24 months (75% versus 92% and 41% versus 91%). In the multivariate analysis, two factors were found to be significantly and independently associated with mortality: serum albumin < 3.5g/dL [hazard ratio 6.68, CI: 1.27-33.05; p = 0.025] and light chain MM (HR 7.34; CI: 1.63-49.4; p = 0.009). Conclusions: Renal involvement is a common complication of multiple myeloma and these patients have poor survival. Therefore, it is of crucial importance to have a high suspicion index to do an early diagnosis and to promote early and aggressive management of renal insufficiency and myeloma. However, this worse outcome seems to be related to the presence of other markers of poor prognosis, like more advanced stages of disease, higher tumour loads and lower values of haemoglobin and albumin, since renal disease was not a risk of death in the multivariate analysis.