Lin Zi-Shan, Yu Xiao-Juan, Zhang Xu, Wang Su-Xia, Cen Xi-Nan, Zhou Fu-De, Zhao Ming-Hui
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.
Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, People's Republic of China.
Cancer Manag Res. 2021 May 13;13:3879-3888. doi: 10.2147/CMAR.S301818. eCollection 2021.
Monoclonal immunoglobulin-associated renal lesions in patients with newly diagnosed myeloma vary. We aimed to determine the pathological spectrum and analyze associated prognostic factors.
Fifty-six patients with newly diagnosed multiple myeloma and biopsy-proven renal lesions were enrolled. Kidney biopsies were reanalyzed, and the baseline clinical characteristics, treatments and outcomes were recorded.
Fifty-one patients had monoclonal immunoglobulin-associated renal lesions, with myeloma cast nephropathy (MCN) being the most common pattern. We divided our cohort into pure MCN, MCN+ other pathologies and non-MCN. Patients with MCN had more severe renal injury than those with non-MCN. In our cohort, none of the patients with pure MCN or MCN + other pathologies presented with nephrotic syndrome. Patients with non-MCN had better renal and overall survival than those with pure MCN but similar survivals to those with MCN + other pathologies. Number of myeloma casts (HR 1.08, p = 0.012) was the only independent prognostic factor for renal survival. Male sex (HR: 3.64; p = 0.015) and number of casts (HR: 1.17; p = 0.001) were independent prognostic factors for overall survival.
Patients with MCN had more severe renal injury than those with non-MCN. Patients with non-MCN had better renal and overall outcomes than those with pure MCN, but their outcomes were similar to those with MCN + other pathologies. The independent predictors of overall survival were male sex and number of myeloma casts.
新诊断骨髓瘤患者中与单克隆免疫球蛋白相关的肾脏病变各不相同。我们旨在确定其病理谱并分析相关的预后因素。
纳入56例新诊断的多发性骨髓瘤且经活检证实有肾脏病变的患者。对肾脏活检标本进行重新分析，并记录基线临床特征、治疗情况及预后。
51例患者有与单克隆免疫球蛋白相关的肾脏病变，其中骨髓瘤管型肾病（MCN）最为常见。我们将队列分为单纯MCN、MCN+其他病理类型和非MCN。MCN患者的肾损伤比非MCN患者更严重。在我们的队列中，单纯MCN或MCN+其他病理类型的患者均未出现肾病综合征。非MCN患者的肾脏和总生存期比单纯MCN患者更好，但与MCN+其他病理类型患者的生存期相似。骨髓瘤管型数量（HR 1.08，p = 0.012）是肾脏生存的唯一独立预后因素。男性（HR：3.64；p = 0.015）和管型数量（HR：1.17；p = 0.001）是总生存的独立预后因素。
MCN患者的肾损伤比非MCN患者更严重。非MCN患者的肾脏和总体预后比单纯MCN患者更好，但与MCN+其他病理类型患者的预后相似。总生存的独立预测因素是男性和骨髓瘤管型数量。
