#5902 KIDNEY INVOLVEMENT IN HAEMATOLOGICAL MALIGNANCIES: THE IMPORTANCE OF EARLY NEPHROLOGICAL REFERRAL

Abstract

Abstract Background and Aims Kidney is often injured in the setting of hematological malignancies. Although, kidney involvement negatively influences the prognosis of these patients, often the referral to clinical nephrology is late. The aims of this study were to investigate the long-term outcomes of haematological diseases with renal involvement demonstrated by kidney biopsy and the association between nephrological referral earliness and survival. Method Monocentric retrospective study evaluating overall survival (OS) (time to death) and renal free survival (RFS) (time to renal replacement therapy) in patients affected by hematologic malignancies with renal involvement demonstrated by kidney biopsy. Data have been collected by January 1st 2009 to December 30th 2021. Results reported as median (min-max) and percentage (%). Results 46 patients; M/F = 1.3; age: 70 years (39.5-91.2). Follow-up: 17,8 months (0.13-125.4). Data at kidney biopsy: creatinine was 3.13 mg/dL (0.6-14), eGFR was 20 ml/min/1.73 m2 (3-110), proteinuria was 5.1 g/24h (0.15-38.6), Bence-Jones proteinuria detected in 74% of patients. Clinical presentations: AKI (63.1%), Nephrotic syndrome (36.9%). Patient referral by Nephrologist (28.2%), Hematologist (26.1%), General Practitioner (21.7%); Emergency Department (17.4%), Others (6.6%). The most frequent histological diagnosis was amyloidosis (32.7%), followed by cast nephropathy (19.2%). Renal Replacement Therapy was required in 41.3% patients. Treatment: 38 patients underwent chemotherapy (56.4% complete/very good hematologic response; 12.8% partial and 30.6% without response). Overall Survival at 24 months was 63.8% and it was reduced in patients with AKI at presentation (Fig. 1) and in patients without treatment response (Fig. 2). RFS was shorter in patients who presented with AKI and affected by Myeloma Cast. Early Nephrological referral was associated with a better RFS (Fig. 3). Conclusion Haematological malignancies with renal involvement causing AKI have the worst prognosis. Kidney biopsy has a prognostic significance and early nephrological referral associated with haematological treatment response correlate with a better renal outcome. These data point to the central role of a multidisciplinary team aimed to the detection and treatment of renal damage due to hematologic malignancies.