Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate clinicopathological features and prognosis in the patients with multiple myeloma and renal diseases.
Ｍｅｔｈｏｄｏｌｏｇｙ：One hundred twelve patients diagnosed as multiple myeloma with renal diseases were enrolled into this retrospective study. Their clinical and renal pathological findings were reviewed, and kidney as well as patients' survival was also evaluated.
Ｒｅｓｕｌｔｓ：They were 78 males and 34 females with male predominance. The clinical features shown that nephrotic proteinuria presented in 464%, and nephritic syndrome in 98% of the patients. The percentage of microscopic hematuria and renal insufficiency were 259% and 688% respectively. According to kidney biopsy findings, renal lesions were divided into multiple myelomarelated lesions（759%）, nonmultiple myelomarelated lesions（188%）, combined（18%） and almost normal biopsy（35%）. Myeloma cast nephropathy（MCN） was the commonest multiple myelomarelated renal lesion, followed by monoclonal immunoglobulin deposition disease（MIDD） and amyloidosis. The serum creatinine at renal biopsy was highest and renal pathology also showed prominent acute tubular injury in MCN. Clinical features favoring amyloidosis over MIDD and MCN included older age, absence of kidney failure, presence of nephrotic syndrome and λ free chain predominance. The occurrence of hematuria was higher in patients with MIDD than MCN or amyloidosis. Patients with MIDD were more likely to have κ free chain in examining serum free light chain and moderate to severe tubular atrophy and interstitial fibrosis in renal histology. The survival of patients with multiple myelomarelated renal lesions was worse than that of patients with nonmultiple myelomarelated renal lesions. In patients with multiple myelomarelated renal lesions, renal survival of patients with AMY was better than that of patients with MCN and MIDD.
Ｃｏｎｃｌｕｓｉｏｎ：The spectrum of renal lesions in patients with multiple myeloma was heterogeneous. Clinical and histological characteristics varied according to renal diseases. Kidney biopsy was useful for identifying the renal lesions and severity and predicting prognosis.