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A non-invasive differential diagnostic model for light chain cast nephropathy in newly diagnosed multiple myeloma patients with renal involvement: a multicenter study

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Abstract

Objective

Light chain cast nephropathy is the most common form of renal lesion in multiple myeloma. Kidney impairment caused by light chain cast nephropathy can be reversed and survival can be improved if early diagnosis is available. It is thus of imperative importance to develop a non-invasive method to diagnose light chain cast nephropathy once the kidney biopsy is not always applicable.

Methods

We consecutively screened newly diagnosed multiple myeloma patients with kidney biopsies from 4 centers in China. Kidney pathologies were reviewed and clinical presentations were recorded. Then a diagnostic model was established by logistic regression and the predictive values were assessed.

Results

Between 1 June 1999 and 30 June 2019, a kidney biopsy was performed in 94 patients with newly diagnosed multiple myeloma, and light chain cast nephropathy was the most common pattern, seen in 52% of biopsied patients. The diagnostic model was established by multivariate logistic regression analysis as P(z) = 1/(1 + e−z) and z = − 0.093 Hemoglobin (g/L) + 0.421 Serum albumin (g/L) + 3.463 Acute kidney injury (0/1) − 9.207 High-density lipoprotein (mmol/L). If P(z) ≥ 0.55, the diagnosis pointed to light chain cast nephropathy; if P(z) < 0.55, the diagnosis favored non-light chain cast nephropathy. The area under the receiver operating characteristic curves was 0.981 (95% CI 0.959, 1.000). The model had a sensitivity of 93.9%, a specificity of 95.6%, a positive predictive value of 96.0%, a negative predictive value of 94.0%, and a total consistency of 95.0%.

Conclusion

We built a novel, non-invasive diagnostic model through a multicenter study, which may be helpful in the diagnosis of light chain cast nephropathy in newly diagnosed multiple myeloma patients.

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Data availability

The data generated and analyzed during the present study are under the domain of the corresponding author and will be made available upon request and evaluation.

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Funding

This work was supported by the National Natural Science Foundation of China (Grant Number: 81470956) and CAMS Innovation Fund for Medical Sciences (Grant Number: 2019-I2M-5–046). Those providing funds had no role in study design, data collection and analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Renal Pathology Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, People’s Republic of China

    Zi-Shan Lin, Ai-Bo Qin, Su-Xia Wang, Xiao-Juan Yu, Fu-De Zhou & Ming-Hui Zhao

  2. Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, 100034, People’s Republic of China

    Su-Xia Wang

  3. Department of Nephrology, People’s Hospital of Peking University, Beijing, 110102, People’s Republic of China

    Bao Dong

  4. Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen, 518036, People’s Republic of China

    Zu-Ying Xiong

  5. Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 640104, People’s Republic of China

    Meng-Hua Chen

  6. Peking-Tsinghua Center for Life Sciences, Beijing, 100034, People’s Republic of China

    Ming-Hui Zhao

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  1. Zi-Shan Lin
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Contributions

Z.S.L contributed to the concept and design, collected the data, performed the statistical analysis and wrote the manuscript. A.B.Q performed the statistical analysis. S.X.W and X.J.Y reviewed the kidney pathologies. B.D, Z.Y.X and M.H.C collected the data. F.D.Z designed, supervised the study and revised it critically. M.H.Z revised the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Fu-De Zhou.

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All the authors declare that they have no conflicts of interests.

Ethical approval

This study was in accordance with the Declaration of Helsinki and was approved by the ethics committee of Peking University First Hospital (2017[1280]).

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Written informed consent was obtained from each patient and the copy of the written consent is available upon request.

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Informed written consent was obtained from each patient for publication of their collected and analyzed data.

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Lin, ZS., Qin, AB., Wang, SX. et al. A non-invasive differential diagnostic model for light chain cast nephropathy in newly diagnosed multiple myeloma patients with renal involvement: a multicenter study. J Nephrol 34, 1169–1177 (2021). https://doi.org/10.1007/s40620-020-00926-7

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  • DOI: https://doi.org/10.1007/s40620-020-00926-7

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