POS-203 MULTIPLE MYELOMA AND RENAL IMPAIREMENT :DESCRIPTIVE STUDY ABOUT 53 CASES IN NEPHROLOGY DEPARTEMENT

Abstract

Multiple myeloma disease is a malignant proliferation of a monoclonal plasma cells producing inadequately an immunoglobilin or its fargments. It represents 1% of cancers and 10% of malignant hemopathies. Renal impairement is a frequent and severe complication in multiple myeloma (MM), it remains a poor prognostic factor and associated with a significant impact in survival. We performed a retrospective study on 53 patients diagnosed multiple myeloma with renal impairement over a period of eleven years from december 2007 to june 2019 at nephrology departement in University Hospital Sahloul Sousse in Tunisia. We determined the epidemiological, clinical, biological, and the evolution features of kidney injury related to myeloma. The mean age of our patients was 63.53 years +/- 11.49 years with extremes ranging from 41 years to 85 years. A maximum of frequency is observed in the age group between 46 years and 59 year. We noted a male predominance of 54,7% versus 45,3% with a sex ratio=1,2. The mean time from onset of symptoms to first consultation was 9.6 weeks +/- 11.2 weeks. Renal involvement was inaugural in 75,5%, only 24,5% of patients had already been followed for MM in the hematology departement. The most commen clinical features were: Anemia symptoms in 71,7%, impaired general condition in 67,3%, bone pain in 41,5%, deshydratation in 34,4%, inection in 34%, oligoanuria 24,5%. The mean serum creatinine was 693.47 umol / L with extremes of 24 and 2012 umol / L. The mean eGFR was 13.94 ml / min / 1.73 m2 with extremes of 1.1 ml / min and 102.27 ml / min / 1.73 m2. CKD was found in 52.8%. ARI on admission was found in 81.1%. 35.8% of patients underwent dialysis on admission and 41,5% pregressed to terminal stage of chronic kidney disease. The mean proteinuria was 3.11g / 24h +/- 2.79 with extremes of 2.19 and 2.97g / 24h. nophrotic syndrom was present in 22,6% of patiens. Renal biopsy was performed in 23 cases It showed myeloma cast nephropathy in 14 patients, AL amyloidosis in 9 patients, a case of membranoproliferative glomerulonephritis (MPGN) and a case of membranous nephropathy (MN). The majority of patients received a chemotheray (80,8%), only 7 patients had a graft of hematopoietic stem cells .26,4% of cases showed a favorable renal evolution and 73,6% had a bad evolution of renal function. The mean of overal survival was 17,97. The major cause of death was infectious complications and progression of the disease. Renal impairement in MM is a commen complication that worsen the prognosis of the disease.Treating early and efficacy with new chemotheray drugs can stop or delay the progression and improve survival outcomes.