INTENSIVE TREATMENT OF RENAL-FAILURE IN PATIENTS WITH MYELOMA

We have reviewed our experience in the management of myeloma patients who present with features of severe renal impairment, to examine the r ole of intensive treatment of the renal failure, and to assess the rol e of renal biopsy. Between March 1983 and August 1991, 16 patients, wh o were subsequently diagnosed as having myeloma, presented to the Depa rtment of Penal Medicine for investigation of renal failure; nine with symptoms of uraemia and seven with pneumonia, bone pain, emphysema, o r ischaemic heart disease. Penal biopsy was performed on 14 patients. Eleven patients had myeloma cast nephropathy, two of whom had concurre nt hypertensive nephropathy, two patients had light chain deposition d isease, and one patient had interstitial nephritis. Renal function imp roved in six patients with aggressive rehydration, but three of them s ubsequently required dialysis. In all 11 patients required dialysis, t wo short-term and nine long-term. Seven patients were given convention al melphalan and prednisolone and nine patients received VAMP as induc tion cytotoxic chemotherapy. Five of the VAMP sub-group received inter feron alpha 2b as maintenance therapy. The median renal survival was f ive months (range 0-36 months) and median overall survival was 20 mont hs (range 1-54 months). We conclude that intensive treatment, includin g dialysis, in myeloma patients with renal failure may result in survi val durations approaching those of unselected myeloma patients, and a significant proportion will enjoy a reasonable quality of life.