CLINICOPATHOLOGICAL PROFILE AND RENAL INVOLVEMENT IN PLASMA CELL DYSCRASIAS: A SINGLE CENTRE EXPERIENCE FROM EASTERN INDIA

Introduction:

Plasma cell dyscrasias encompass a spectrum of disorders characterized by clonal proliferation of plasma cells. The involvement of kidney in plasma cell dyscrasias, including multiple myeloma, is widespread. At the time of presentation, up to 50% of the patients have kidney involvement, which is associated with higher mortality.1 Renal manifestations can range from mild dysfunction to acute kidney injury (AKI) and nephrotic syndrome.1,2 This study highlights the understanding of clinicopathological profiles and renal involvement in plasma cell dyscrasias for early diagnosis and intervention to prevent the progression to end-stage kidney disease (ESKD).

Methods:

This retrospective cross-sectional study was done in the Department of Nephrology in collaboration with Department of Pathology at AIIMS, Patna. During the 6 months’ study from January,2024 to June,2024; we identified 16 cases of plasma cell dyscrasia. Renal biopsy was done in 9 patients while bone marrow study was done for all patients. Patients’ demographic, clinicopathological, and biochemical data was reviewed from the electronic data system. All data was stored and analyzed using SPSS version 22 software.  

Results:

Out of 16 patients, 13 (81%) were men and 3 (19%) were women; male-to-female ratio was 4.3:1. Median age was 57 years (range: 42-82 years). The most common symptoms were bone pain (69%) and fatigue (56%). Among plasma cell dyscrasias, majority were diagnosed with multiple myeloma (87.5%), followed by AL Amyloidosis (12.5%). Most patients presented with renal dysfunction at baseline (81.2%) followed by nephrotic syndrome in 12.5% patients. Lytic bone lesions were present in 68%. Serum creatinine levels ranged from 0.9 to 14 mg/dL, with a mean of 4.62 mg/dL. 41.2% patients exhibited serum creatinine levels above 5 mg/dL. 8 (50%) patients were dialysis requiring at presentation of which majority (6 patients) progressed to ESKD with dialysis dependence for lifetime. Also, here the majority (44%) patients had light chain cast nephropathy as the primary diagnosis. Within 3 months, 37.5% patients had renal recovery during the treatment. Corrected calcium levels ranged from 8.5 to 14.5 mg/dL, with a mean of 10.77 mg/dL. Hypercalcemia was observed only in 43.7% patients. Hemoglobin levels ranged from 4.5 to 12 g/dL, with a mean of 8.43 g/dL. Anemia (hemoglobin <10 g/dL) was observed in 87.5% patients. The mean serum albumin level was 3.02 g/dL (range: 2–4.5 g/dL). 62.5% patients had hypoalbuminemia (serum albumin <3.5 g/dL). Elevated globulin levels were seen in 68.75% (11/16) of patients, with levels ranging from 2.18 to 11.5 g/dL. A reversed albumin/globulin (A/G) ratio was present in 87.5% of the patients. Active urinary sediments were observed in 68.75% patients. The mean 24-hour urine protein excretion was 1335 mg/day, with 12.5% patients displaying nephrotic-range proteinuria. Urine Bence zone protein was absent in most cases (81.2%). Serum protein electrophoresis was performed in all patients and showed positive M- protein. Serum immunofixation was done in 10 patients, identifying IgG lambda (50%) as the most common monoclonal gammopathy, followed by IgG kappa (40%). Renal biopsy performed in 9 patients had most common light chain cast nephropathy with lambda restriction (55%), followed by AL Amyloidosis (22%). Bone marrow aspiration performed in all patients showed that 25% had bone marrow plasma cells greater than 60%, while the majority (62.5%) had plasma cells in the range of 10-60%. 

Conclusions:

This study highlights the diverse renal manifestations of monoclonal gammopathy and the critical need for thorough clinicopathological evaluation. Light chain cast nephropathy was the most common finding, with many patients presenting with significant renal dysfunction, a large proportion of whom required dialysis. Early recognition and intervention are essential to prevent progression to end-stage kidney disease and to improve patient outcomes.

References :

 1. Vakiti A, Padala SA, Hashmi MF, Mewawalla P. Renal Disease in Monoclonal Gammopathies. StatPearls 2024 Mar 4. StatPearls Publishing.

2. Sinha R, Parwaiz A, Satyajeet, Rani SN, Surabhi, Kumar T. Clinicopathological spectrum of multiple myeloma: Experience of an institute in Eastern India. Hematol Int J. 2022;6(1):220.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.