Improving The Diagnostic Pathway In Patients Presenting With Acute Kidney Injury Secondary To De Novo Multiple Myeloma: A Short Report

Multiple myeloma (MM) has a prolonged diagnostic pathway, with a median time to diagnosis of 163 days.1 Renal impairment is a common complication of MM and is associated with worse outcomes. Cast nephropathy resulting in acute kidney injury (AKI) is a medical emergency and the time to initial treatment with chemotherapy is pivotal for renal recovery and patient outcome. Patients can present to various specialties and initial symptoms can be vague, making diagnosis challenging and resulting in diagnostic delay. In order to identify where delays occur, we reviewed the diagnostic pathway in patients with de novo MM with AKI at two tertiary centres in the UK. We identified delays within this clinical pathway and sought to implement a change in order to speed up the time to disease-specific treatment. Our aim was to improve the timeline to diagnosis by nearly 50%. We retrospectively reviewed the electronic records of patients who presented to the two centres: University Hospitals Birmingham (UHB) and Oxford University Hospitals (OUH), with AKI of any stage and serum free light chain (sFLC) concentration of ≥500 mg/L between 1 April 2015 and 31 December 2017. Patients known to have MM were excluded. A total of 56 patients were identified, 28 from each centre. Table 1 summarises the results of the two centres. Patients had most commonly been referred to hospital from primary care (41%). The median time to sFLC request was 1 day and median time to initial treatment with dexamethasone was 5 days. The longest delay was waiting for a bone …