title: [Clinical features of multiple myeloma patients with renal insufficiency as the initial clinical manifestation].
abstract: OBJECTIVE
  To analyze the clinical features of multiple myeloma (MM) with renal insufficiency as the initial manifestation, and to improve the level of clinical diagnosis of MM, and reducing misdiagnosis of this disease.
  
  
  METHODS
  To retrospectively analyze the clinical data of 140 patients with MM, who were admitted in our Department of Nephrology and Hematology. They were diagnosed as MM by bone marrow aspiration biopsy. The patients were divided into renal insufficiency group and normal renal function group, based on the criterion of serum creatinine >177 μmol/L. The two groups were statistically analyzed byt test, rank sum test,χ(2) test and binary logistic regression analysis.
  
  
  RESULTS
  55.7% of the patients in the renal insufficiency group presented low level of three immunoglobulin classes (IgG, IgA, IgM), while in the normal-renal function group, 54.3% of patients mainly presented IgG subtype, showing statistically significant differences between the two groups (P<0.001). Univariate analysis showed that IgM level (<0.4 g/L), hemoglobin, white blood cells, erythrocyte sedimentation rate (ESR), total protein, globulin, uric acid, corrected serum calcium, proteinuria and hematuria were statistically significantly different between the two groups (P<0.05 for all). Unconditional logistic regression analysis showed that lower level of IgM (OR=19.992, 95%CI: 1.327-301.202), hemoglobin, uric acid, ESR, serum total protein, proteinuria and hematuria are independent risk factors for the development of renal insufficiency in MM patients (P<0.05 for all).
  
  
  CONCLUSIONS
  Low level of IgM (<0.4 g/L) is an important clinical characteristics of MM patients with renal insufficiency as the initial clinical manifestation. For middle-aged and elderly patients, who present as low levels of three IgG classes (IgG, IgA, IgM) or low level of IgM, multiple myeloma should be excluded, so as to reduce the misdiagnosis.
authors.affiliation: Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
authors.forename: R X
authors.initials: RX
authors.lastname: Ma
authors.affiliation: Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
authors.forename: Z L
authors.initials: ZL
authors.lastname: Li
authors.affiliation: Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
authors.forename: G H
authors.initials: GH
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Health Statistics, Qingdao University Medical College, Qingdao 266021, China.
authors.forename: Y L
authors.initials: YL
authors.lastname: Wu
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D007958:Leukocyte Count; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000378:metabolism; D011507:Proteinuria; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007136:Immunoglobulins; D003404:Creatinine