Kidney Damage in Multiple Myeloma: Clinical, Biological, Histological and Therapeutic Aspects at the Chartres Hospital Center

Abstract

Introduction: Multiple myeloma is a haematological malignancy characterised by monoclonal plasma cell proliferation in the bone marrow, which synthesises a serum and/or urinary monoclonal protein, associated with one or more manifestations including (anaemia, hypercalcaemia, bone lesions, renal failure). The aim of our work was to determine the prevalence, clinico-biological, histological and therapeutic manifestations of renal damage during multiple myeloma. Methodology: This is a retrospective descriptive study spread over a period of 2 years from 01 January 2020 to 31 December 2021 carried out in the nephrology department of the louis pasteur hospital of the CH of Chartres. All patients treated for multiple myeloma with renal involvement were included, whether the renal involvement was revelatory or diagnosed during the follow-up of the multiple myeloma. Results: We collected 20 cases of myeloma. Renal involvement was present in 19 cases (95%). The mean age was 68.78 ± 10.77 years with extremes ranging from 44 to 82 years. Males were more prevalent, with an M/F sex ratio of 3.75. The most common antecedent condition was hypertension in 14 cases (73.7%) and diabetes in 4 cases (21.1%). The circumstances of discovery were renal failure in 16 cases (84.2%), followed by bone pain in 6 cases (31.6%). Renal involvement was dominated by renal failure in 18 cases (94.7%), hypercalcaemia in 14 cases (73.7%), para protein in 9 cases (47.4%), haematuria and leukocyturia in 5 cases (26.3%). On plasma protein electrophoresis, 11 cases (57.9%) had kappa light chain multiple myeloma, 8 cases (42.1%) had lambda light chain multiple myeloma. We noted 9 cases (69%) of myelomatous cylinder nephropathy at renal biopsy, Randall’s disease in 2 cases (15%), AL amyloidosis and acute tubular necrosis in 1 case (8%). First-line chemotherapy treatment was dominated by the combination of Velcade, cyclophosphamide and dexamethasone in 5 cases (79%). Conclusion: Renal involvement in myeloma is still common; it may be isolated and precede the first signs of myeloma by several months; the most common histological forms are myelomatous cylinder nephropathy and Randall’s disease.