SUN-436 CLINICOPATHOLOGICAL PROFILE OF RENAL DISEASE IN PARAPROTEINEMIA AND MONOCLONAL GAMMOPATHY OF RENAL SIGNIFICANCE

Abstract

Presence of kidney injury in Plasma cell dyscrasias confers increased mortality. Several pathogenic mechanisms can contribute to renal failure in patient with myeloma, some of which are the result of nephrotoxic monoclonal Ig and some of which are independent of paraprotein deposition. Often multiple pathologies co-exist and contributes to renal failure. AIM:To study the clinical and pathological profile of renal diseases in patients with paraproteinemia and monoclonal gammopathy of renal significance. To study renal and patient outcome in such patients. This was a retrospective cum prospective observational study between March 2013 to July 2019 on the clinical profile, hematological characteristics, renal biopsy findings and outcome among 54 patients with either multiple myeloma or monoclonal gammopathy of renal significance (MGRS) as defined by international myeloma working group (IMWG) The males to female ratio was 1.8: 1(n=54). The mean age was 59 ± 8.03 years. Multiple myeloma criteria were meet in 65%(n=35) and MGRS in 35%(n=19). Rapidly progressing renal failure (RPRF) was the most common presentation 48% (n=26) followed by nephrotic syndrome 26%(n=14). The most common renal pathology was cast nephropathy 24 %(n=13). In MGRS the most common presentation was nephrotic syndrome 36.8% (n=7 out of 19) and light chain deposition disease (LCDD) 36.8%(n=7) the most common pathology. Out of the 28 (52%) patients requiring dialysis only 2 became dialysis independent at 1 month, and 17 (32%) patients died. Bortezomib based therapy was given in 17 (31.4%) patients. Infection rate were significantly higher in bortezomib group 70.5% (n=12) compared to non-bortezomib group 40.5%(n=15) (p-value is .04). Statistically significant factors associated with mortality were male sex, age more than 60 years, RPRF presentation, dialysis requiring renal failure, overt myeloma, cast nephropathy, and underlying diabetes mellitus.Table 1spectrum of plasma cell dyscrasia associated renal pathologyRenal pathology #Number of patients (n=54)MGRS (n=19)Cast nephropathy (CN)13 (24%)4 (21%)Amyloidosis (AL)9 (6.6%)6 (31.5%)CN + light chain deposition disease (LCDD)10 (18.5%)2 (10.5%)LCDD10 (18.5%)7 (36.8%)PGNMID (proliferative glomerulonephritis with monoclonal Ig deposition)1 (1.8%)0LCPT (light chain proximal tubulopathy)1(1.8%)0Cryoglobulinemic glomerulonephritis2(3.6%)0Biopsy not done8 (14.8%)0#46 patients out of 54 underwent renal biopsy. Open table in a new tab #46 patients out of 54 underwent renal biopsy. Most common presentation was rapidly progressive renal failure. Most common pathology seen was cast nephropathy. Patients with cast nephropathy had poor outcome.