Abstract: SA-PO0113
Prognostic Value of Kidney Biopsy in Multiple Myeloma
Session Information
- AKI: Clinical Diagnostics and Biomarkers
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Won, Alice H., Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Khanna, Soumya, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
Renal disease occurs in 50% of multiple myeloma (MM) patients, and acute kidney injury (AKI) is the usual presentation with 10% of patients requiring dialysis at diagnosis. There is a variety of renal diseases with unique histopathologic features associated with MM. However, it is unclear whether specific histopathologic features found in kidney biopsy have prognostic value for predicting kidney outcomes in the management of AKI in MM patients.
Methods
We performed a single center retrospective cohort study of 35 patients with kidney biopsy in the setting of AKI, between 2014-2025, with a final diagnosis of either MM, smoldering MM (SMM), amyloidosis, monoclonal gammopathy of renal significance (MGRS), or monoclonal gammopathy of unclear significance (MGUS). We reviewed the histopathologic features and correlated these findings to the patients’ severity of AKI, renal outcomes including dialysis initiation, and mortality.
Results
All 35 patients had varying degree of glomerulosclerosis, with 10 patients (29%) only having features of global glomerulosclerosis with no other significant histopathology while the remaining 25 patients had other specific features. Of these 25 patients, diabetic kidney disease, monoclonal deposition disease/MIDD, and amyloidosis represented the majority. Mean baseline renal function of the total cohort was largely similar across different histopathologies with sCr (in mg/dL) between 1.0-2.0 and eGFR (in mL/min/1.73m2) between 40-60, representing underlying CKD. However, patients with amyloid and FSGS had lower mean baseline sC. Mean peak sCr was highest for a single case of interstitial nephritis at 9.4 (with eGFR of 4) compared to the mean peak sCr of the total cohort of 2.7 (with eGFR of 34). 3 out of the 6 patients who experienced death had progressed to end-stage renal disease requiring dialysis. Thrombotic microangiopathy and amyloidosis represented the highest rate of dialysis initiation and death.
Conclusion
Patients with MM and related plasma cell dyscrasia develop AKI with various renal histopathologic features and may prognosticate renal outcomes.