Myeloma renal disease: presentation and outcome.

BACKGROUND

Renal disease can be the first presentation of multiple myeloma (MM) or develop during the disease process.

AIM

To define the mode of presentation of MM to nephrologists and determine the association with patient characteristics and outcome.

METHODS

MM patients referred to a tertiary renal unit were studied retrospectively. Group I presented to nephrologists prior to MM diagnosis (n = 36); group II was referred to nephrology after diagnosis (n = 27), and group III was known only to haematology and never referred (n = 91). Age at presentation, gender, paraprotein type, need for dialysis, haematological and biochemical parameters, and survival were examined.

RESULTS

Of the 154 MM patients, 23.4% presented with renal impairment (group I), 17.5% were referred to nephrology after MM diagnosis (group II) and 59.1% did not receive renal input (group III). On presentation, group I had a median serum creatinine (sCr) of 700 (range 341-1,023) micromol/l and 80% required dialysis. Although the median sCr on presentation for group II was 131 (range 103-373) micromol/l, median sCr on renal referral was 554 (range 181-807) micromol/l and 57% needed dialysis. In contrast, the median sCr on presentation for group III was only 99 (range 85-117) micromol/l. Group I was more anaemic (p < 0.001) and had higher beta(2)-microglobulin levels (p < 0.0001) on presentation compared to groups II and III. For groups I and II, the median survival after diagnosis (10.2 vs. 24.7 months, p = 0.11) and renal referral (10.5 vs. 20.0 months, p = 0.68) was not significantly different.

CONCLUSION

Survival in myeloma renal disease remains poor regardless of the mode of presentation to nephrologists.