MULTIPLE-MYELOMA AND RENAL-FAILURE - ONE CENTERS EXPERIENCE

Renal involvement remains a major complication of multiple myeloma, pa rticularly in advanced disease. A retrospective analysis was performed of the modes of presentation, treatment and outcome of all patients w ith multiple myeloma treated in our renal unit between 1987 and 1996 T hirty-four patients were identified: in 26 (76%) the diagnosis of myel oma was made only after referral. Light chains were the most common pa raprotein in both serum and urine. Twenty-one (62%) patients underwent renal biopsy: myeloma cast nephropathy was the predominant histologic al finding in 16 cases. Thirty-one (91%) patients had severe renal fai lure (GFR < 20 mL/min), with 28 (82%) requiring dialysis within 2 week s of admission. Despite treatment of presumed precipitating causes of acute deterioration in renal function, only 1 of these 28 patients sub sequently became independent of dialysis. Most had advanced stage myel oma: 29 (85%) were Durie-Salmon stage II or III. Hypercalcemia, sepsis and pathological fractures were the principal complications. Median s urvival overall was 5 months. The main causes of death were withdrawal of renal replacement therapy (overwhelming myeloma, severe debilitati on) and sepsis. Nineteen (56%) patients received long-term (> 1 month) renal replacement therapy with a median survival of 8 months. However , five of these (26%) have survived for more than 12 months on dialysi s and report a good quality of life.