Avaliação da função renal dos pacientes com mieloma múltiplo antes e após o tratamento
Data
2022
Autores
César, Bruno Nogueira 
Orientadores
Durão Junior, Marcelino de Souza
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O mieloma múltiplo (MM) representa 1 a 2% de todos os cânceres significando aproximadamente 18,7% das doenças onco-hematológicas. É mais comum entre homens e afrodescendentes. A disfunção renal é complicação comum e é fator de risco para desfechos negativos (morbimortalidade) nesses indivíduos. A lesão renal pode se apresentar de várias formas, sendo a mais característica a nefropatia por cilindros de cadeia leve (rim do mieloma). Novas drogas foram incorporadas ao tratamento. Resultados melhores são alcançados e agora uma porcentagem significante de pacientes apresenta recuperação da função renal, inclusive menor dependência de diálise. Retrospectivamente, analisamos a função renal dos pacientes com MM, durante o 1º ano de tratamento. Resultados: a amostra total foi de 167 pacientes, a idade média era de 66 (±11,49) anos. A comorbidade mais prevalente foi hipertensão arterial (76, 45,5%). A maioria dos pacientes apresentava classificação International Staging System (ISS) avançada, 3 (73, 43,7%) ou 2 (60, 35,9%). Setenta e quatro pacientes (44%) manifestaram taxa de filtração glomerular estimada (TFGe) < 60 ml/min/1,73m² na apresentação clínica. Cinquenta e dois pacientes (31%) foram submetidos a transplante de células-tronco hematopoiéticas (TCTH). Quatro (2,3%) necessitaram diálise e dezoito (10,7%) faleceram. Fatores associados à TFGe < 60 ml/min/1,73m² foram anemia, hiperuricemia, proteinúria de 24 horas > 1,0 grama e presença de plasmocitoma extramedular. As variáveis associadas a melhor resposta renal, ao final do primeiro ano, foram TFGe basal (prévia ao diagnóstico) ≥ 60 ml/min/1,73m² e a realização de TCTH.
Multiple myeloma (MM) Multiple myeloma (MM) represents 1 to 2% of all cancers, meaning approximately 18,7% of onco-hematological diseases. Kidney function impairment is a common complication and a risk factor for increase morbimortality in these individuals. Kidney injury can present in several ways, and the main finding is light chain cast nephropathy (myeloma kidney). New drugs have improved responses. Better results have been reached and now a large number of patients have recovered kidney function. Retrospectively, we analyzed the kidney function of patients with MM during the first year of treatment. Results: we evaluated 167 patients; the mean age was 66 (±11,49) years. The most prevalent comorbidity was arterial hypertension (76, 45,5%). The majority of patients had advanced International Staging System (ISS) classification, 3 (73, 43,7%) or 2 (60, 35,9%). Seventy-four patients (44%) had estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m² at disease presentation. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). Four (2.3%) required dialysis and 18 (10.7%) died. Factors associated with eGFR < 60 ml/min/1.73m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 grams, and diagnosis of extramedullary plasmacytoma. The variables associated with better kidney response at the end of the first year were baseline eGFR ≥ 60 ml/min/1.73m² and HSCT.
Multiple myeloma (MM) Multiple myeloma (MM) represents 1 to 2% of all cancers, meaning approximately 18,7% of onco-hematological diseases. Kidney function impairment is a common complication and a risk factor for increase morbimortality in these individuals. Kidney injury can present in several ways, and the main finding is light chain cast nephropathy (myeloma kidney). New drugs have improved responses. Better results have been reached and now a large number of patients have recovered kidney function. Retrospectively, we analyzed the kidney function of patients with MM during the first year of treatment. Results: we evaluated 167 patients; the mean age was 66 (±11,49) years. The most prevalent comorbidity was arterial hypertension (76, 45,5%). The majority of patients had advanced International Staging System (ISS) classification, 3 (73, 43,7%) or 2 (60, 35,9%). Seventy-four patients (44%) had estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m² at disease presentation. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). Four (2.3%) required dialysis and 18 (10.7%) died. Factors associated with eGFR < 60 ml/min/1.73m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 grams, and diagnosis of extramedullary plasmacytoma. The variables associated with better kidney response at the end of the first year were baseline eGFR ≥ 60 ml/min/1.73m² and HSCT.