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Percentage of urinary albumin excretion and serum-free light-chain reduction are important determinants of renal response in myeloma patients with moderate to severe renal impairment.

Sugihara H, Chihara D, Seike K, Fukumoto K, Fujisawaa M, Suehara Y, Nishida Y, Takeuchi M, Matsue K - Blood Cancer J (2014)

Bottom Line: There is no reliable test for predicting reversibility of RI in MM patients.We postulated that MM with high albuminuria may reflect glomerular disease that is difficult to reverse.Here, we examined the impact of urinary albumin excretion.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba, Japan.

ABSTRACT
Reversal of renal dysfunction significantly affects the prognosis of multiple myeloma (MM) with renal impairment (RI). There is no reliable test for predicting reversibility of RI in MM patients. We postulated that MM with high albuminuria may reflect glomerular disease that is difficult to reverse. Here, we examined the impact of urinary albumin excretion. We retrospectively analyzed 279 patients admitted to our hospital from April 2000 to December 2013. Clinical variables and laboratory data that may affect myeloma treatment response were extracted. The results were examined for relationship to renal response by univariate and multivariate analysis. RI (estimated glomerular filtration rate ≦50 ml/min per 1.73 m(2)) was observed in 116 patients (46%) and renal responses of renal complete response, renal partial response, renal minor response and no response were obtained in 46 (40%), 15 (13%), 13 (11%) and 42 (36%) patients, respectively. Although renal recovery was significantly associated with Durie-Salmon 1 or 2 (P=0.02), myeloma response better than very good partial response (P=0.03), involved free light-chain (iFLC) reduction from baseline 80% at day 12 (P=0.005), ≧95% at day 21 (P<0.001) and urinary albumin ≦25% on admission (P<0.001) on univariate analysis, only reduction of iFLC 95% at day 21 (P=0.015) and urinary albumin ≦25% (P=0.007) remained significant for any renal response. Our observation indicates that increased urinary albumin excretion >25% and reduction of iFLC ≦95% on day 21 were associated with favorable renal recovery in MM patients with RI, and were considered as negative predictors for renal response.

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ROC analysis of % of urinary albumin excretion for obtaining any renal response in patients with RI. The urinary albumin excretion of 24.0% was identified by ROC analysis with specificity 0.658, sensitivity 0.740 and AUC 0.666 with 95% CI of 0.545–0.
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fig2: ROC analysis of % of urinary albumin excretion for obtaining any renal response in patients with RI. The urinary albumin excretion of 24.0% was identified by ROC analysis with specificity 0.658, sensitivity 0.740 and AUC 0.666 with 95% CI of 0.545–0.

Mentions: Patients with RI and renal response showed significantly lower percentage of urinary albumin compared with those without renal response (Table 1, P=0.007). The best cutoff value of 24.0% urinary albumin excretion was identified by ROC analysis, which had specificity of 65.8%, sensitivity of 74.0% and AUC of 0.666 with 95% CI of 0.545–0.0.786 (Figure 2). Therefore, we set 25% of urinary albumin as the cutoff value for further analysis. Among the 111 patients with renal response, both any renal response and major renal response (≧PRenal), median iFLC, eGFR and iFLC reduction on days 12 and 21 were associated with less urinary albumin excretion ≦25%. However, median OS was not different between patients with urinary albumin ≦25% and those with urinary albumin >25% (Table 2).


Percentage of urinary albumin excretion and serum-free light-chain reduction are important determinants of renal response in myeloma patients with moderate to severe renal impairment.

Sugihara H, Chihara D, Seike K, Fukumoto K, Fujisawaa M, Suehara Y, Nishida Y, Takeuchi M, Matsue K - Blood Cancer J (2014)

ROC analysis of % of urinary albumin excretion for obtaining any renal response in patients with RI. The urinary albumin excretion of 24.0% was identified by ROC analysis with specificity 0.658, sensitivity 0.740 and AUC 0.666 with 95% CI of 0.545–0.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219465&req=5

fig2: ROC analysis of % of urinary albumin excretion for obtaining any renal response in patients with RI. The urinary albumin excretion of 24.0% was identified by ROC analysis with specificity 0.658, sensitivity 0.740 and AUC 0.666 with 95% CI of 0.545–0.
Mentions: Patients with RI and renal response showed significantly lower percentage of urinary albumin compared with those without renal response (Table 1, P=0.007). The best cutoff value of 24.0% urinary albumin excretion was identified by ROC analysis, which had specificity of 65.8%, sensitivity of 74.0% and AUC of 0.666 with 95% CI of 0.545–0.0.786 (Figure 2). Therefore, we set 25% of urinary albumin as the cutoff value for further analysis. Among the 111 patients with renal response, both any renal response and major renal response (≧PRenal), median iFLC, eGFR and iFLC reduction on days 12 and 21 were associated with less urinary albumin excretion ≦25%. However, median OS was not different between patients with urinary albumin ≦25% and those with urinary albumin >25% (Table 2).

Bottom Line: There is no reliable test for predicting reversibility of RI in MM patients.We postulated that MM with high albuminuria may reflect glomerular disease that is difficult to reverse.Here, we examined the impact of urinary albumin excretion.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba, Japan.

ABSTRACT
Reversal of renal dysfunction significantly affects the prognosis of multiple myeloma (MM) with renal impairment (RI). There is no reliable test for predicting reversibility of RI in MM patients. We postulated that MM with high albuminuria may reflect glomerular disease that is difficult to reverse. Here, we examined the impact of urinary albumin excretion. We retrospectively analyzed 279 patients admitted to our hospital from April 2000 to December 2013. Clinical variables and laboratory data that may affect myeloma treatment response were extracted. The results were examined for relationship to renal response by univariate and multivariate analysis. RI (estimated glomerular filtration rate ≦50 ml/min per 1.73 m(2)) was observed in 116 patients (46%) and renal responses of renal complete response, renal partial response, renal minor response and no response were obtained in 46 (40%), 15 (13%), 13 (11%) and 42 (36%) patients, respectively. Although renal recovery was significantly associated with Durie-Salmon 1 or 2 (P=0.02), myeloma response better than very good partial response (P=0.03), involved free light-chain (iFLC) reduction from baseline 80% at day 12 (P=0.005), ≧95% at day 21 (P<0.001) and urinary albumin ≦25% on admission (P<0.001) on univariate analysis, only reduction of iFLC 95% at day 21 (P=0.015) and urinary albumin ≦25% (P=0.007) remained significant for any renal response. Our observation indicates that increased urinary albumin excretion >25% and reduction of iFLC ≦95% on day 21 were associated with favorable renal recovery in MM patients with RI, and were considered as negative predictors for renal response.

Show MeSH
Related in: MedlinePlus