MULTIPLE MYELOMA AND SEVERE RENAL FAILURE: A CLINICOPATHOLOGIC STUDY OF OUTCOME AND PROGNOSIS IN 37 PATIENTS WITH BIOPSY PROVEN MYELOMA CAST NEPHROPATHY

L BELL 1, Z LI 1, B CHACKO 1

1Hunter New England LHD, Newcastle, Australia

Aim: To evaluate the prognosis of patients presenting with acute kidney injury (AKI) and myeloma cast nephropathy (MCN), and the impact of different treatment strategies in these patients.

Background:MCN carries significant mortality and morbidity, including dialysis-dependence. The prognostic value of renal biopsies in MCN is debated, as are benefits of novel therapies and high cut-off dialysis (HCOD). This study contributes to these discussions and evaluates the prognosis of patients presenting with AKI and membranous cast nephropathy.

Methods:A retrospective study over two years was conducted on 57 patients from our centre from 1992-2018. Patients presented with an acute kidney injury with biopsy-confirmed MCN. Patients were divided into either treatment “Responsive” or “Non-Responsive” based on dialysis dependence and eGFR at 3 months, with a cut-off of greater than 30ml/min/1.73m2. Baseline characteristics, treatment strategy and follow-up information was collected and compared across these groups.

Results: 37 patients were included for analysis, 27 responded to treatment and 10 did not at 3 months. Mean survival from presentation was 17.5 months. Significantly lower mortality at 1 year and lower dialysis-dependence at 1 and 2 years was found for “Responder” patients. Severity of acute kidney injury was a significant factor determining response to treatment. Severity of median tubular atrophy and interstitial fibrosis was higher in “Non-Responder” patients. Use of high-cut off dialysis (HCOD) and more modern bortezomib-based therapy had favourable results, with HCOD significantly improving mortality at 1-year.

Conclusion: For patients presenting with AKI and MCN, progress at 3 months has a significant impact on prognosis. HCOD and bortezomib therapies appear to have improved outcomes, and increased tubular atrophy/interstitial fibrosis trended towards worse prognosis.


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