Nephrology Dialysis Transplantation, Vol 13, Issue 6 1438-1445, Copyright © 1998 by Oxford University Press
J Montseny, D Kleinknecht, A Meyrier, P Vanhille, P Simon, A Pruna and D Eladari
Background: The prognosis of monoclonal gammopathies
with multiple myeloma and renal involvement is poor, and the indication for
renal replacement therapy is controversial. Few studies address the value
of renal histology for determining prognosis according to initial pathology
findings. Methods: We studied the course of 118
patients with multiple myeloma according to renal biopsy lesions. The
monoclonal component was identified and quantified in serum and urine.
Tumor cell mass was classified as stage 1, 2 or 3, according to Durie and
Salmon. End-points were death, or survival on dialysis, or serum creatinine
level at last examination. Results: Renal biopsy
showed myeloma kidney in 48 cases (41%), AL-amyloidosis in 35 (30%), light
chain deposit disease in 22 (19%), chronic tubulointerstitial nephritis in
12 (10%) and cryoglobulinaemic kidney with multiple myeloma in 1.
Maintenance haemodialysis was required in 46 patients (39%), earlier
(P<0.0001) in myeloma kidney (mean: 3 months after diagnosis) than
in AL-amyloidosis (mean: 15 months) and light chain deposit disease (mean:
18 months). Median survival was 12 months in myeloma kidney, 24 months in
AL-amyloidosis and 48 months in light chain deposit disease. Dialysis
increased survival in light chain deposit disease, in contrast with myeloma
kidney and AL-amyloidosis patients whose survival was shorter when
dialysed. The main cause of death during first year of dialysis was cardiac
involvement in AL-amyloidosis, and sepsis or cardiac insufficiency in
myeloma kidney. There was a trend to increased survival with multidrug
chemotherapy which seemed to slow progression to end-stage renal failure.
At last follow-up (median: 12 months, range 1-297), 65 (55%) patients had
died. By multivariate analysis, independent predictors of survival were:
age <70, serum creatinine ⩽300 &mgr;mol/l, and serum
calcium ⩽2.5 mmol/l. Conclusions: Initial
renal biopsy helps predict prognosis in patients with multiple myeloma and
renal involvement. Maintenance haemodialysis is a reasonable indication in
light chain deposit disease and AL-amyloidosis, especially in patients aged
<70. Multidrug therapy tends to prolong survival and slow
progression to end-stage renal disease. Key words:
amyloidosis; chronic haemodialysis; chronic renal failure; light chain
disease; myeloma; renal biopsy
ORIGINAL ARTICLES
Long-term outcome according to renal histological lesions in 118 patients with monoclonal gammopathies
Service de Néphrologie et Réanimation Polyvalente, Centre Hospitalier, 56 Bd de la Boissière, F-93105 Montreuil, France; Service de Néphrologie, Hôpital Broussais, Paris, France; Services de Néphrologie, Centre Hospitalier de Valenciennes, Saint-Brieuc and Saint-Loius, Paris, France; Corresponding author
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