Clinical features of multiple myeloma patients with renal insufficiency as the initial clinical manifestation
10.3760/cma.j.issn.0253-3766.2016.07.014
- VernacularTitle:肾功能不全为首发临床表现多发性骨髓瘤的临床特征
- Author:
Ruixia MA
1
;
Zuolin LI
;
Tong WANG
;
Guohua WU
;
Yili WU
Author Information
1. 266003,青岛大学附属医院肾内科
- Keywords:
Subject words] Multiple myeloma;
Renal insufficiency;
Immunoglobulin M
- From:
Chinese Journal of Oncology
2016;38(7):552-555
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical features of multiple myeloma ( MM ) with renal insufficiency as the initial manifestation, and to improve the level of clinical diagnosis of MM, and reducing misdiagnosis of this disease. Methods To retrospectively analyze the clinical data of 140 patients with MM, who were admitted in our Department of Nephrology and Hematology. They were diagnosed as MM by bone marrow aspiration biopsy. The patients were divided into renal insufficiency group and normal renal function group, based on the criterion of serum creatinine>177μmol/L. The two groups were statistically analyzed by t test, rank sum test,χ2 test and binary logistic regression analysis. Results 55.7% of the patients in the renal insufficiency group presented low level of three immunoglobulin classes ( IgG, IgA, IgM) , while in the normal?renal function group, 54. 3% of patients mainly presented IgG subtype, showing statistically significant differences between the two groups ( P<0.001) . Univariate analysis showed that IgM level (<0.4 g/L), hemoglobin, white blood cells, erythrocyte sedimentation rate (ESR), total protein, globulin, uric acid, corrected serum calcium, proteinuria and hematuria were statistically significantly different between the two groups ( P<0.05 for all) . Unconditional logistic regression analysis showed that lower level of IgM ( OR=19.992, 95% CI: 1. 327?301. 202 ) , hemoglobin, uric acid, ESR, serum total protein, proteinuria and hematuria are independent risk factors for the development of renal insufficiency in MM patients ( P<0.05 for all). Conclusions Low level of IgM (<0.4 g/L) is an important clinical characteristics of MM patients with renal insufficiency as the initial clinical manifestation. For middle?aged and elderly patients, who present as low levels of three IgG classes ( IgG, IgA, IgM) or low level of IgM, multiple myeloma should be excluded, so as to reduce the misdiagnosis.
