The diagnostic and prognostic utility of serum free light chains in patients presenting with renal impairment in multiple myeloma.

Yadav, Punit Ramsamujh (2019). The diagnostic and prognostic utility of serum free light chains in patients presenting with renal impairment in multiple myeloma. University of Birmingham. M.D.

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Abstract

Renal impairment (RI) in multiple myeloma (MM) is a medical emergency and is associated with adverse prognosis. In this thesis, I have focussed on the diagnostic and prognostic utility of serum FLC levels and kidney function in patients with MM including those with biopsy proven myeloma cast nephropathy (MCN) and, to identify factors that were associated with overall survival in patients who recover kidney function from a dialysis-dependent state.

I found a strong relationship between higher serum FLC levels at diagnosis and the severity of RI, with a greater sensitivity and specificity for a FLC level >800 mg/L with severe RI irrespective of the paraprotein type. Renal function at diagnosis was a key determinant of RI post induction (PI). Patients who attained a very good partial response (VGPR) or above were more likely to achieve renal function recovery at PI. Ninety-eight percent of patients with MCN at diagnosis presented with a serum FLC level >500 mg/L. Serum FLC level at diagnosis was not associated with patient outcomes in MCN. Renal function recovery within 12 months was associated with improved survival in patients with MCN when compared to those who remained dialysis-dependent.

Lastly, I also found better long term overall survival in patients with MCN who remained dialysis-independent, and an early serum FLC reduction as well asduration on dialysis were associated with future renal function.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):