PRESENTATION AND SURVIVAL OF PATIENTS WITH SEVERE RENAL-FAILURE AND MYELOMA

We reviewed the clinical features and outcome of 56 patients with myel oma and severe renal failure managed in a single institution over a 15 -year period. Renal failure was recognized within 2 months of the diag nosis of myeloma in 75% of patients, and was the initial presentation of myeloma in 50%. Patients were staged by the Durie and Salmon classi fication. Light-chain and IgD myeloma accounted for 46% of cases, and Bence-Jones proteinuria was identified in >90%. In 43%, a potential pr ecipitant of renal failure was identified, usually hypercalcaemia or a non-steroidal anti-inflammatory agent. A preserved corrected calcium at presentation was characteristic (2.40 +/- 0.15 mmol/l, n = 42), eve n after excluding those with hypercalcaemia requiring specific interve ntion (n = 14, 2.76 +/- 0.51 p<0.01): this finding in patients with un explained acute renal failure should alert clinicians to the possibili ty of myeloma. Forty-seven patients (84%) required dialysis. Only seve n (15%) ever regained renal function. Median survival (all patients) w as 8 months. One-third died within 3 months of referral and one-third survived >1 year. Hypoalbuminaemia and reduced platelet count at prese ntation were associated with reduced survival, but hypercalcaemia, inf ection, dialysis (urgent or long-term), and dialysis modality were not . Chemotherapy was associated with increased survival, but progression of myeloma and infection were the two most frequent causes of death. Severe renal failure was associated with advanced myeloma stage and li ght-chain/IgD paraproteinaemia. Survival was related to severity of my eloma and not requirement for dialysis per se.