Renal failure in multiple myeloma. A study of the presenting findings, response to treatment and prognosis in 26 patients.

The presenting clinical features, response to treatment and survival duration of 26 consecutive multiple myeloma patients with renal failure at diagnosis were investigated. All but 1 of the patients had high tumour cell mass stage, as identified by one (3 cases) or more (22 cases) of the criteria defined by Durie and Salmon. Survival length of azotaemic patients was significantly shorter than that of stage III patients with normal renal function (median: 4 months vs 41 months, respectively, P less than 0.0005), and was positively affected by reversal of renal failure following treatment (P less than 0.0005). Of the 26 patients, 56% achieved reversal of renal failure. Recovery of normal renal function was prompt in most of the cases and appeared to be independent from both M component type and pretreatment serum creatinine levels. Finally, it was shown that patients with reversible renal impairment but with myeloma unresponsive to alkylating agents had early recurrence of impaired renal function and a shorter life expectancy than patients with a significant decrease in tumour cell mass.