The incidence and treatment of kidney disease caused by multiple myeloma in China

Introduction

A clonal B-cell cancer of the bone marrow, multiple myeloma (MM) can present with a range of clinical symptoms, such as anemia, renal impairment, infection and bone disease. The primary cause of renal failure in multiple myeloma (MM) patients is myeloma cast nephropathy, which is brought on by the precipitation of monoclonal light chain (LC) with the Tamm-Horsfall protein form casts that obstruct renal distal tubule lumens. Apart from myeloma cast nephropathy, other glomerulopathies are linked to multiple sclerosis (MM), such as monoclonal immunoglobulin deposition disease (MIDD) and LC amyloidosis (AL). Chronic renal failure and nephrotic syndrome were more common in these patients. The hallmark of AL is deposits of LC (mostly lambda LC) that are Congo-red-positive and consist of nonbranched fibrils with an exterior diameter of 10–12 nm.

MIDD is found in the tubular, glomerular, and vascular basement membranes as amorphous granular monoclonal immunoglobulin deposits. either in electron microscopy or immunofluorescence. MIDD encompasses heavy-chain deposition disease, lightand heavy-chain deposition disease, predominantly deposits of kappa LC, and LC deposition disease (LCDD). MM is the second most common hematological malignancy and makes up 1% of all malignancies. The median age at diagnosis for multiple myeloma (MM) is 70 years old, with an estimated 120,000 cases occurring annually worldwide ^[1]. China has 0.6/100,000 cases of MM, a significantly lower frequency than 12.7/100,000 cases in Africa. Furthermore, among all hematologic malignancies, MM is ranked third in China, behind non-Hodgkin’s lymphoma and leukemia ^{[2, 3]}.

Renal function impairment affects between 15 and 40 percent of all MM patients. There were discrepancies in the definition of renal damage in these investigations, which led to a wide range in assessment [4–11]. At the time of diagnosis, the serum creatinine (Scr) levels of about 30–40% of the MM patients were higher than normal. According to data from the Asia Myeloma Network, which included 3,405 MM patients, 23.4% of MM patients had renal function impairment upon diagnosis (classified as Scr >2 mg/dl). This number is 24% in the Chinese mainland, 19.7% in Hong Kong, 30.8% in Taiwan, 16.1% in Japan (the lowest), and 33.5% in Korea (the highest) according to this study ^[12].

According to Zhao et al. ^[13], 30.5% and 78% of the MM patients, respectively, had creatinine clearance rates (Ccr) of less than 30 ml/min and less than 90 ml/min. In the United States, patients with end-stage renal illness have an incidence of 1.0% and a prevalence rate of 0.3% of MM ^[14]. According to ERAEDTA data, the incidence of end-stage renal disease associated with multiple sclerosis rose from 0.7 pmp in 1986–1990 to 2.52 pmp in 2001–2005 ^[15]. For China, we do not have any pertinent statistics, though. CLINICAL CHARACTERISTICS AND DIAGNOSIS While renal AL or LCDD are uncommon, renal tubular damage and renal failure are the most common presentations in patients with IgG and IgA MM-induced kidney diseases.

Remarkably, compared to other patients, those with LC and IgD MM typically have a higher incidence of renal injury. Other than injury to the tubules, A prevalent condition that eventually results in renal AL or LCDD and manifests as nephritic syndrome is glomerular damage. Of all LC MM patients, renal failure affects over 50%. Over 90% of IgD MM patients experience renal failure, despite the disease having a 1% prevalence. Based on the research conducted by Kim and colleagues.Of all Asian heavy-chain type MM patients, patients with IgG, IgA, IgD, LC, and nonsecretory MM made up 55.2, 22, 3.1, 17.9, and 1.9%. correspondingly. According to Chow et al. ^[16], renal insufficiency was present in 22.2% of MM patients in Hong Kong at the time of diagnosis; the LC type was most common in this situation.

Of the 211 MM patients in our kidney department, 40.8% had IgG MM, 20.9% had IgA MM, 7.6% had IgD MM, and 20.9% had LC MM. The percentages of renal insufficiency were 62.8, 59, 75, and 86.4%, in that order. The ratios for nephrotic syndrome were 10.5, 15.9, 18.8, and 9.1%, in that order. Renal biopsy was done on 61 patients (28.9%); 26 patients Treatment: Over 50% of MM patients who get effective treatment see improvements in their renal function and a decrease in plasma LC concentration. The purpose of MM treatment is to obtain longer period of progressionfree survival and more thorough remission. Chemotherapy regimens for multiple myeloma have evolved significantly in the last ten years.

The prognosis is improved and the remission rate is greatly increased by the use of new medications (such bortezomib) and peripheral blood autologous stem cell transplantation (ASCT). Traditionally, vincristine plus doxorubicin plus dexamethasone, high-dose dexamethasone, and melphalan and prednisone were used as chemotherapeutic treatments for multiple myeloma. These treatments were still in use in China due to financial constraints.The first-in-class proteasome inhibitor to be licensed for the treatment of multiple myeloma is called boratezomib. Bortezomib has a higher treatment efficiency than conventional chemotherapy. Bortezomib has been suggested by the NCCN (National Comprehensive Cancer Network). For primary and refractory MM, monotherapy or combination therapy is used. Even in patients receiving dialysis, boratezomib is thought to be safe and beneficial in the treatment of multiple sclerosis patients with renal injury of any severity ^[25].

It has been confirmed that bortezomib has an effect in several phase III investigations. GFR rates of ≤30, 31–50, and >50 ml/min were observed in 6, 27, and 67% of MM patients receiving VMP (bortezomib, melphalan, and prednisone; n = 344) in the VISTA study.The complete response (CR) was 37, 29, and 30%, corresponding to an efficiency rate of 74, 67, and 72%; 44% of the patients their renal function was restored ^[26]. Regretfully, the only research done in China has been retrospective, using small sample sizes and brief follow-up periods. In a prospective trial, Li et al. ^[27] reported on 18 newly diagnosed MM patients with renal impairment (Scr >2 mg/dl), or a mean creatinine level of 5.3 mg/dl.

Patients and Methods

were given.

Conclusion

For patients with MM, kidney damage is the most frequent consequence. The course of therapy has advanced significantly in recent years. In patients with renal failure, bosentasomib is currently considered the first-line treatment because to its significantly increased efficacy, extended survival duration, and lack of need for dose modification. It is used more frequently. in China and has positive outcomes, even with the comparatively high price of bortezomib. In patients with multiple myeloma who also have renal failure, we currently lack expertise with ASCT. Hemodialysis has the potential to enhance prognosis, particularly high cutoff hemodialysis. There is new hope for the treatment of MM patients with renal failure when new medication chemotherapy is paired with delayed high cutoff extended hemodialysis; more research is definitely required.

Conflict of Interest

Statement: We certify that we have no personal or financial ties to any individuals or groups that might have improperly impacted our work.

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