Multiple myeloma and renal failure in the 21.century, experiency of Gazi Universty

Multiple myelom is a clonal plasma cell neoplasm that is accounted for approximately %1 of all malignancies. Renal failure is an important complication and also prognostic factor of multiple myeloma, and presented as %20 of patients at the time of diagnosis. Renal failure in multiple myeloma is associated with early mortality and shortened survival. It is reported that survival disavantage disappears with the reversal of renal failure. Renal failure is affecting the course of disease in various ways. Therefore it is important to determine the factors contributing to reversal of renal failure.In this study, renal failure accompanying with MM has been evaluated by laboratory variables and radiologic procedure in retrospective manner. Renal failure risk factors, survival analysis and prognostic factors contributing the reversal of renal failure have been assesed. The purpose is to gain an foresight about prognosis of patients with MM and renal failure that have worse outcome and management problems. 136 patients whom diagnosed in Hematology and Nephrology Departments of Gazi Universty School of Medicine between 2000-2010, are included and evaluated retrospectively in this study. Renal failure is defined by a serum creatinin higher than 2mg/dl and the incidence of renal failure is found 17,6% (n=24). Precipitating factors for developing renal failure are; nonsteroidal anti inflammatory drugs (p<0,03) , use of contrast agents (p<0,04) and hyperuricemia (p<0,02). Patients are divided in two groups consisted of having renal failure or not. ISS stage 3 and high risk patients (p<0,001) and light chain disease (p=0,02) are more common in renal failure group. In addition, pathologic findings, like increase in renal echogenicity and small kidneys by renal ultrasound are more frequent (%60) in this group (p<0,001).Factors that contributing the reversal of renal failure are also studied. High serum creatinin level (p=0,02), requiring renal replacement with dialysis (p=0,03), hypertension (p=0,05), low serum calcium level (p=0,04) and increase in renal echogenicity or small kidneys by renal ultrasound (p=0,009) are determined as prognostic factors for reversal of renal failure.Contributing factors for developing renal failure are nonsteroidal anti inflammatory drugs, use of contrast agents and hyperuricemia. Pathologic renal ultrasound findings and hypertension may be accepted as prognostic factors for reversal of renal failure.