Clark A D, Shetty A, Soutar R
Beatson Institute for Cancer Research, Garscube Estate, Bearsden, Glasgow, UK.
Blood Rev. 1999 Jun;13(2):79-90. doi: 10.1016/s0268-960x(99)90014-0.
Renal impairment is a common complication of multiple myeloma occuring in 50% of patients at some stage in their disease. Pathogenesis is multifactorial. Nephrotoxic manifestations of monoclonal immunoglobulin overexpression include the 'myeloma kidney', light chain deposition disease, AL amyloid, plasma cell infiltration and glomerulonephritis. Other factors, such as hypercalcaemia, hyperuricaemia, infection, hyperviscocity and nephrotoxic drugs can precipitate or exacerbate acute and chronic renal failure. Aggressive treatment has dramatically improved outcome in patients who present with acute or acute-on-chronic renal failure. Dialysis has become an accepted treatment acutely and in end stage renal disease due to myeloma. Conventional therapy with melphalan and prednisolone is still advocated for elderly patients. However, renal failure is not a contraindication to aggressive cytoreduction, stem cell collection, double hemibody radiotherapy and autologous transplantation in those otherwise fit to tolerate these procedures. Prognosis is primarily determined by the response of the myeloma clone to chemotherapy. Outcome in chemosensitive patients approaches that of patients with equivalent disease stage without renal dysfunction.
肾功能损害是多发性骨髓瘤的常见并发症，50%的患者在疾病的某个阶段会出现该并发症。其发病机制是多因素的。单克隆免疫球蛋白过度表达的肾毒性表现包括“骨髓瘤肾病”、轻链沉积病、AL淀粉样变性、浆细胞浸润和肾小球肾炎。其他因素，如高钙血症、高尿酸血症、感染、高黏滞血症和肾毒性药物，可促使或加重急性和慢性肾衰竭。积极治疗显著改善了急性或慢性肾衰竭患者的预后。透析已成为骨髓瘤所致急性肾衰竭和终末期肾病的一种公认治疗方法。对于老年患者，仍提倡使用美法仑和泼尼松进行传统治疗。然而，对于那些身体状况适合耐受这些操作的患者，肾衰竭并非积极细胞减灭、干细胞采集、双半身放疗和自体移植的禁忌证。预后主要取决于骨髓瘤克隆对化疗的反应。化疗敏感患者的预后接近无肾功能障碍的同等疾病阶段患者。
