Multiple Myeloma in Chronic Kidney Disease

Introduction: The incidence of multiple myeloma (MM) has increased in Scotland over the last 20 years. Approximately 25% of cases present directly to renal services. Serum electrophoresis is commonly included in the diagnostic screening tests performed in patients with chronic kidney disease (CKD). We examined the utility of serum electrophoresis in the population presenting to renal outpatient services in Glasgow. Methods: All new patient attendances at general nephrology clinics in the Glasgow renal units between 1/08/2004 and 31/07/2006, along with clinical data, were retrieved from the electronic patient records. Patients with acute kidney injury were excluded. All serum and urine electrophoresis requests and results for the same period were identified from Biochemistry and Immunology Laboratory Services. Results: A total of 2,544 new patients attended a renal clinic for the first time in the inception period, of whom 1,608 (63.2%) had serum electrophoresis tested. One patient with MM was identified, but the diagnosis was clinically apparent before the serum electrophoresis result was requested. A further 40 subjects had abnormal serum electrophoresis with mean paraprotein of 8.3 g/l (SD 6.1); none of these patients have subsequently developed MM, and the renal Received: March 19, 2008 Accepted: July 3, 2008 Published online: November 22, 2008 A. Doyle Renal Unit , Queen Margaret Hospital Whitefield Rd. Dunfermline, KY12 0SU (UK) Tel. +44 1383 623 623, Fax +44 1383 627 096, E-Mail [email protected] © 2008 S. Karger AG, Basel 1660–2110/09/1111–0007$26.00/0 Accessible online at: www.karger.com/nec Doyle /Soutar /Geddes Nephron Clin Pract 2009;111:c7–c11 c8 gree of renal failure at presentation is generally moderate and reversible in up to 50% of patients, particularly when it is related to precipitating factors such as hypercalcemia [8–11] . The British Committee for Standards in Haematology currently suggest a pathway of screening for the presence of paraproteins that is depicted in figure 1 . The initial step is to perform serum and urine electrophoresis, progressing to immunoelectrophoresis and then to isoelectric focusing and immunofixation, in order to better define any suspected paraprotein identified [12] . The aim of this retrospective study was to determine the utility of electrophoresis as a screening test in the population presenting to renal outpatient services in Glasgow.