It is known that renal failure carries a poor prognosis to patients with multiple myeloma (MM), reducing the survival from 36 to 18 months [1]. The prognosis is even worse in patients without renal function recovery [2,3]. Most studies addressed patients with renal failure and newly diagnosed MM. To our knowledge, there is no information on the outcome of patients who develop acute renal failure during MM chemotherapy.
We retrospectively studied 26 patients with MM and renal failure, admitted to a university hospital, between 1998 and 2003. Patients with known chronic renal failure or those who were submitted to bone marrow transplantation were excluded. We compared patients who had renal failure at the time of MM diagnosis and had not received any MM treatment (group 1, n = 15) with patients who developed renal failure after MM diagnosis and were already under treatment (group 2, n = 11). Statistical analysis was performed using unpaired t-test, 2 test and KaplanMeier survival curve.
The frequency of severe infection, need for ICU, mechanical ventilation or vasoactive agents was similar. Also the distribution of MM classes was similar in both groups: 7/15 IgG, 2/15 IgA, 1/15 IgM and 4/15 light chain in group 1 compared with 6/11, 2/11, 0/11 and 3/11 in group 2. Group 1 presented higher levels of serum ß2-microglobulin (25.4±4.1 vs 8.7±3.4 mg/ml, P<0.01) and Bence-Jones proteinuria >1 g/24 h (11/11 vs 6/9, P = 0.04), but other markers of MM severity were similar to group 2 (Table 1).
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Survival was much better in group 1. At 30 days, it was 67% vs 18% (P = 0.01), as shown in the Figure 1. This difference in mortality was not explained by clinical deterioration or MM therapeutic refractoriness.
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Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo Disciplina de Nefrologia São Paulo, SP Brazil Email: alexandreliborio{at}yahoo.com.br
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