Clinical Analysis Of Patients With Myeloma-related Renal Impairment

Objective: To analyze the characteristics and risk factors of myeloma-related renal impairment so as to enhance understanding and management of myeloma-related renal injury.To observe the efficacy of removing serum free light chain(FLC)and inflammatory mediators by hemofiltration-reinfusion(HFR)adsorption in a patient with myeloma-related renal impairment on the basis of chemotherapy.Methods: Retrospective analysis was performed on the clinical data of 161 cases of clearly diagnosed symptomatic(active)multiple myeloma(MM)patients admitted to the hematology department of Zunyi Medical University affiliated hospital from January 2017 to December 2019.MM patients with renal impairment who had excluded other possible renal impairment factors were screened according to serum creatinine,glomerular filtration rate(eGFR)and urinary changes,and their general demographic data,clinical characteristics,laboratory data and treatment status were collected.According to the International Myeloma Working Group(IMWG)and Kidney Disease Improving Global Outcomes(KDIGO)related to the definition and performance,myeloma-related renal impairment was divided into three conditions:(A)chronic kidney disease(CKD),(B)acute kidney injury(AKI),(C)myeloma renal insufficiency,and the risk factors was analyized.To observe the efficacy of removing serum FLC and inflammatory mediators by HFR technique in patient with myeloma-related renal impairment,HFR technique was used in 1 MM patient with heavy proteinuria and abnormal elevated serum FLC on the basis of chemotherapy.Results:1.Among 161 MM patients,there were 86 cases(53.42%)of myeloma-related renal impairment,including 46 cases(28.57%)of CKD,20 cases(12.42%)of AKI,and 6 cases(3.73%)of pure protein or protein hematuria,among which 59 cases(36.65%)of renal insufficiency met IMWG standard.2.Among 86 patients with myeloma-related renal impairment,the male to female ratio was 1.32:1,and the majority of patients were elderly,mostly IgG type and light chain type,with bone pain as the first symptom common,and mainly degenerative lumbar degeneration and rib bone destruction.Most of the 86 patients with myeloma-related renal impairment were treated with bortezomic-based chemotherapy,with complete renal response accounted for 16.28%,partial response accounted for 3.49%,and minor response accounted for 11.63%,and finally 5 patients died.3.Multivariate Logistic regression showed that high blood phosphorus,high plasma cell ratio and low hemoglobin were independent risk factors for CKD,high blood phosphorus,high uric acid and low hemoglobin were independent risk factors for AKI,high blood phosphorus,high uric acid,urinary Bence-Jones protein and low hemoglobin were independent risk factors for myeloma renal insufficiency.4.In one MM patient with heavy proteinuria and abnormal elevated serum FLC,the average level of blood FLC decreased by 57.59%(8.51-84.76%)after 12 times of HFR administration,and the level of filtrate FLC decreased by more than 90% after 15 minutes of adsorption.Serum C-reactive protein,beta-2 microglobulin,and albumin decreased by20.16%,52.07%,and 5.48%,respectively,and interleukin-6 increased by 6.66%.Conclusion:1.The incidence of renal impairment in MM patients is very common,which may be CKD,AKI,and proteinuria or protein-hematuria,among which MM renal insufficien is 36.65%.In patient with myeloma-related renal impairment,old age,IgG type,light chain type,and bone pain as the first symptom is more common,and missed diagnosis and misdiagnosis rate is also common.2.The occurrence of myeloma-related renal impairment is related to many factors.High blood phosphorus and low hemoglobin are independent risk factors for CKD,AKI,and MM renal insufficiency in MM patient.3.HFR can remove FLC from the blood of MM patients,which should be performed early and the single adsorption time should not exceed 3 hours.