Multiple myeloma and renal failure: one center's experience.
Renal involvement remains a major complication of multiple myeloma, particularly in advanced disease. A retrospective analysis was performed of the modes of presentation, treatment and outcome of all patients with multiple myeloma treated in our renal unit between 1987 and 1996. Thirty-four patients were identified: in 26 (76%) the diagnosis of myeloma was made only after referral. Light chains were the most common paraprotein in both serum and urine. Twenty-one (62%) patients underwent renal biopsy: myeloma cast nephropathy was the predominant histological finding in 16 cases. Thirty-one (91%) patients had severe renal failure (GFR < 20 mL/min), with 28 (82%) requiring dialysis within 2 weeks of admission. Despite treatment of presumed precipitaing causes of acute deterioration in renal function, only 1 of these 28 patients subsequently became independent of dialysis. Most had advanced stage myeloma: 29 (85%) were Durie-Salmon stage II or III. Hypercalcemia, sepsis and pathological fractures were the principal complications. Median survival overall was 5 months. The main causes of death were withdrawal of renal replacement therapy (overwhelming myeloma, severe debilitation) and sepsis. Nineteen (56%) patients received long-term (> 1 month) renal replacement therapy with a median survival of 8 months. However, five of these (26%) have survived for more than 12 months on dialysis and report a good quality of life.
Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
C
C
Magee
J P
JP
Vella
W P
WP
Tormey
J J
JJ
Walshe
D000368:Aged; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors