We reviewed the clinical features and outcome of 56 patients with myeloma and severe
renal failure managed in a single institution over a 15-year period.
Renal failure was recognized within 2 months of the diagnosis of myeloma in 75% of patients, and was the initial presentation of myeloma in 50%. Patients were staged by the Durie and Salmon classification. Light-chain and
IgD myeloma accounted for 46% of cases, and Bence-Jones
proteinuria was identified in > 90%. In 43%, a potential precipitant of
renal failure was identified, usually hypercalcaemia or a
non-steroidal anti-inflammatory agent. A preserved corrected
calcium at presentation was characteristic (2.40 +/- 0.15 mmol/l, n = 42), even after excluding those with hypercalcaemia requiring specific intervention (n = 14, 2.76 +/- 0.51; p < 0.01): this finding in patients with unexplained
acute renal failure should alert clinicians to the possibility of myeloma. Forty-seven patients (84%) required dialysis. Only seven (15%) ever regained renal function. Median survival (all patients) was 8 months. One-third died within 3 months of referral and one-third survived > 1 year. Hypoalbuminaemia and reduced platelet count at presentation were associated with reduced survival, but hypercalcaemia,
infection, dialysis, (urgent or long-term), and dialysis modality were not.
Chemotherapy was associated with increased survival, but progression of myeloma and
infection were the two most frequent causes of death. Severe
renal failure was associated with advanced myeloma stage and light-chain/
IgD paraproteinaemia. Survival was related to severity of myeloma and not requirement for dialysis per se.