| Objective:This paper aims to explore the risk factors of multiple myeloma(MM)related renal impairment(RI)and the factors influencing renal recovery after chemotherapy,so as to provide clinical basis for early intervention and treatment of MM patients with renal impairment(RI).Methods:The clinical data of 117 patients with MM who met the diagnostic criteria of2014 International Myeloma Working Group(IMWG)from January 2015 to December 2020 in Jiangxi Provincial People’s hospital were retrospectively collected.They were divided into normal renal function group and renal impairment group according to the criteria of IMWG objective to study the risk factors of MM related renal impairment.In the renal impairment group,the factors influencing the recovery of renal function were screened according to whether renal reaction occurred after chemotherapy.Result:1.In this study,117 patients with MM were included,the average age of initial diagnosis was 62.1 years old,and the ratio of male to female was 1.34:1.There were55 patients with normal renal function,the average age of initial diagnosis was 62.2years old,and the ratio of male to female was 1.4:1.There were 62 patients with renal impairment,the average age of initial diagnosis was 62 years old,and the ratio of male to female was 1.3:1,there were no significant difference between the two groups in age and gender,but this confirmed the comparability between the two groups.2.In 117 MM patients,the proportion of bone destruction in renal impairment group was higher than that in normal renal function group(93.3% vs 85.5%),and the proportion of infection in renal impairment group was higher than that in normal renal function group(30.6% vs 23.6%),but the difference was not statistically significant.3.The proportion of renal impairment combined with hypertension and diabetes was lower than that of normal renal function group(33.9% vs 34.5%,4.8% vs 14.5%)in MM patients,and the proportion of renal impairment combined with kidney stones was higher than that of normal renal function group(24.2% vs 12.7%),but there were no significant difference between the two groups in hypertension,diabetes and kidney stones.4.The proportion of LAM light chain in renal impairment group(60.7%)was higher than that in normal renal function group(41.8%),and the difference was statistically significant.MM patients with LAM light chain were easy to have renal impairment.5.In this study,ISS staging of normal renal function group: 9 cases in stage I,25 cases in stage II,21 cases in stage III;renal impairment group: 0 cases in stage I,2 cases in stage II,60 cases in stage III.When the results showed that the risk of renal impairment was not equal among different ISS stages,the incidence of renal impairment in MM patients with ISS stage III(74.1%)was higher than that in MM patients with ISS stage I and II,and the difference was statistically significant.6.The comparison of blood routine and biochemical indexes showed that the values of leukocytes,neutrophils,uric acid,serum β2-microglobulin,lactate dehydrogenase,serum corrected calcium in renal impairment group were higher than those in normal renal function group,with statistical significance.7.Univariate logistic regression analysis showed that neutrophils,serum uric acid and serum β2-microglobulin were the main risk factors for MM related renal impairment.The risk prediction model suggested that the sensitivity of serum uric acid and serum β2-microglobulin were better,but the sensitivity and specificity of neutrophils were poor,serum β2-microglobulin had the highest predictive value for MM related renal impairment,and the best cutoff value was 8.155 ug/ L.8.The comparison of clinical data between renal response group and non renal response group after chemotherapy showed that there were significant differences in age and platelet count between the two groups.However,because the sample size was too small,cytogenetic test,serum free light chain decline rate and other indicators related to the recovery of renal function were not included in the study,the factors affecting the recovery of renal function were not further analyzed.conclusion:1.Neutrophils,serum uric acid and serum β2-microglobulin are independent risk factors for MM related renal impairment.The predictive value of serum β2microglobulin was higher than that of neutrophils and serum uric acid.2.Age and platelet count may be the factors that affect the recovery of renal function in MM patients after chemotherapy,and further studies on larger sample size,cytogenetic test,serum free light chain decline rate and other indicators are needed. |
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