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Titolo:
LONG-TERM OUTCOME ACCORDING TO RENAL HISTOLOGICAL LESIONS IN 118 PATIENTS WITH MONOCLONAL GAMMOPATHIES
Autore:
MONTSENY JJ; KLEINKNECHT D; MEYRIER A; VANHILLE P; SIMON P; PRUNA A; ELADARI D;
Indirizzi:
CTR HOSP,SERV NEPHROL,56 BD BOISSIERE F-93105 MONTREUIL FRANCE CTR HOSP,SERV NEPHROL & REANIMAT POLYVALENTE F-93105 MONTREUIL FRANCE HOP BROUSSAIS,SERV NEPHROL F-75674 PARIS FRANCE CTR HOSP,SERV NEPHROL VALENCIENNES FRANCE CTR HOSP,SERV NEPHROL ST BRIEUC FRANCE CTR HOSP,SERV NEPHROL ST LOUIS FRANCE CTR HOSP,SERV NEPHROL PARIS FRANCE
Titolo Testata:
Nephrology, dialysis, transplantation
fascicolo: 6, volume: 13, anno: 1998,
pagine: 1438 - 1445
SICI:
0931-0509(1998)13:6<1438:LOATRH>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMARY SYSTEMIC AMYLOIDOSIS; CHAIN DEPOSITION DISEASE; MULTIPLE-MYELOMA; LABORATORY FEATURES; PROGNOSTIC FACTORS; CHRONIC DIALYSIS; SURVIVAL; FAILURE; AL; TRANSPLANTATION;
Keywords:
AMYLOIDOSIS; CHRONIC HEMODIALYSIS; CHRONIC RENAL FAILURE; LIGHT CHAIN DISEASE; MYELOMA; RENAL BIOPSY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
31
Recensione:
Indirizzi per estratti:
Citazione:
J.J. Montseny et al., "LONG-TERM OUTCOME ACCORDING TO RENAL HISTOLOGICAL LESIONS IN 118 PATIENTS WITH MONOCLONAL GAMMOPATHIES", Nephrology, dialysis, transplantation, 13(6), 1998, pp. 1438-1445

Abstract

Background. The prognosis of monoclonal gammopathies with multiple myeloma and renal involvement is poor, and the indication for renal replacement therapy is controversial. Few studies address the value of renal histology for determining prognosis according to initial pathology findings. Methods. We studied the course of 118 patients with multiplemyeloma according to renal biopsy lesions. The monoclonal component was identified and quantified in serum and urine. Tumor cell mass was classified as stage 1, 2 or 3, according to Durie and Salmon, End-points were death, or survival on dialysis, or serum creatinine level at last examination. Results. Renal biopsy showed myeloma kidney in 48 cases (41%), AL-amyloidosis in 35 (30%), light chain deposit disease in 22(19%), chronic tubulointerstitial nephritis in 12 (10%) and cryoglobulinaemic kidney with multiple myeloma in 1. Maintenance haemodialysis was required in 46 patients (39%), earlier (P<0.0001) in myeloma kidney (mean: 3 months after diagnosis) than in AL-amyloidosis (mean: 15 months) and light chain deposit disease (mean: 18 months), Median survival was 12 months in myeloma kidney, 24 months in AL-amyloidosis and 48months in light chain deposit disease. Dialysis increased survival inlight chain deposit disease, in contrast with myeloma kidney and AL-amyloidosis patients whose survival was shorter when dialysed. The maincause of death during first year of dialysis was cardiac involvement in AL-amyloidosis, and sepsis or cardiac insufficiency in myeloma kidney. There was a trend to increased survival with multidrug chemotherapy which seemed to slow progression to end-stage renal failure. At lastfollow-up (median: 12 months, range 1-297), 65 (55%) patients had died. By multivariate analysis, independent predictors of survival were: age < 70, serum creatinine less than or equal to 300 mu mol/l, and serum calcium less than or equal to 2.5 mmol/l, Conclusions. Initial renal biopsy helps predict prognosis in patients with multiple myeloma andrenal involvement. Maintenance haemodialysis is a reasonable indication in light chain deposit disease and AL-amyloidosis, especially in patients aged <70, Multidrug therapy tends to prolong survival and slow progression to end-stage renal disease.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/09/20 alle ore 00:54:41