Late-stage myeloma invades kidney without significant effect on renal function: findings from 53 autopsies in a single institute
Renal manifestations of multiple myeloma (MM) including cast nephropathy, amyloidosis, and renal calcification have been widely recognized. However, the severity of histopathological findings has not been addressed so far, and the clinical significance of these pathological findings is unclear. We sought to clarify the relationship between the severity of renal pathology and clinical characteristics. We analyzed 53 autopsies performed on patients who died from MM. The kidneys were evaluated using light microscopy, and the severity of pathological findings was recorded. The most common renal lesion was cast nephropathy (n = 27). Other findings included amyloidosis (n = 10), renal calcification (n = 5), microbial infection (n = 4), and MM infiltration (n = 17). The incidence of MM infiltration was substantially higher than previously reported. Renal MM infiltration was detected even when bone marrow plasmacytosis was limited. However, a significantly higher degree of renal MM infiltration was observed when MM cells invaded the liver. No correlation was observed between serum creatinine levels and degree of MM infiltration, but these tended to be elevated when cast nephropathy was severe. These findings may provide clues to understand both renal injury and extramedullary diseases in patients with MM.
KeywordsMultiple myeloma Renal injury Renal infiltration by myeloma Cast nephropathy Extramedullary disease
We are deeply grateful to Dr. Akiyoshi Miwa, Dr. Akira Tanimura, Dr. Risen Hirai, and Dr. Masataka Takeshita.
JT analyzed the data and wrote the paper. SM and MM evaluated the kidney samples. NT contributed essential advice regarding data analysis. SH designed the study.
Compliance with ethical standards
Conflict of interest
The authors have no competing interests.
All procedures followed were in accordance with the ethical standards of the, responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.
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