Prakash J, Niwas S S, Parekh A, Vohra Rubina, Wani I A, Sharma N
Department of Nephrology and Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
J Assoc Physicians India. 2009 Jan;57:23-6.
Multiple myeloma (MM) is a commonly encountered hematological malignancy with significant renal involvement and often presents as renal failure. The aim of the present study is to analyze clinical spectrum of acute renal failure (ARF) in patients with MM.
We analyzed 26 (males 24; females 2) patients of multiple myeloma who were referred for evaluation of ARF between July 1994 - June 2007. The referral diagnosis did not include MM in majority 23 (88%) of the patients. Multiple myeloma was diagnosed by at least two of the four features; (1) lytic bone lesions, (2) serum or urine monoclonal peak, (3) Bence Jones proteinuria and (4) more than 20% plama cells in marrow aspirate.
Multiple myeloma contributes 1.93% of total ARF cases (26/1342) over a period of thirteen years. Mean age of patients was 59.3 +/- 7.4 years. The clinical manifestations of myeloma included; anemia (100%), Bence Jones proteinuria (80%), "M" peak in serum electrophoresis (69%), lytic bone lesions (62%), "M" peak in urine electrophoresis (54%), body pain (58%), plasma cells more than 20% in bone marrow aspirate (38%). Oliguric ARF was seen in 73% patients. The precipitating factors of ARF identified were; hypercalcemia (31%); infection (23%); volume depletion (19%); and NSAIDs in (15%). Dialysis support was needed in 77% of the patients because of severe renal failure at presentation with mean serum creatinine of 9.05 +/- 2.84 mg%. Seventeen patients completed chemotherapy, seven last to follow up and two patients died. Ten (38.5%) patients had complete recovery of renal function; three patients had partial recovery and off dialysis and four patients remained dialysis dependent. Remission of myeloma was achieved in nine of seventeen patients treated with chemotherapy Renal biopsy finding in nine patients revealed-cast nephropathy in (4), amyloidosis in (3), proliferative glomerulonephritis in (1) and cast nephropathy with chronic interstitial nephritis and plasma cell infiltration in one patient.
Acute reversible renal failure is a common complication in MM, multiple myeloma should be considered as cause a cause of unexplained ARF in middle aged and elderly patients.
多发性骨髓瘤（MM）是一种常见的血液系统恶性肿瘤，常伴有严重的肾脏受累，且常表现为肾衰竭。本研究旨在分析MM患者急性肾衰竭（ARF）的临床特征。
我们分析了1994年7月至2007年6月期间因ARF前来评估的26例多发性骨髓瘤患者（男性24例；女性2例）。在大多数（23例，88%）患者中，转诊诊断未包括MM。多发性骨髓瘤通过以下四个特征中的至少两个进行诊断：（1）溶骨性骨病变；（2）血清或尿液单克隆峰；（3）本周氏蛋白尿；（4）骨髓穿刺涂片中浆细胞超过20%。
在13年期间，多发性骨髓瘤占ARF总病例数的1.93%（26/1342）。患者的平均年龄为59.3±7.4岁。骨髓瘤的临床表现包括：贫血（100%）、本周氏蛋白尿（80%）、血清电泳中“M”峰（69%）、溶骨性骨病变（62%）、尿液电泳中“M”峰（54%）、身体疼痛（58%）、骨髓穿刺涂片中浆细胞超过20%（38%）。73%的患者出现少尿型ARF。确定的ARF诱发因素为：高钙血症（31%）；感染（23%）；容量不足（19%）；非甾体抗炎药（15%）。由于就诊时严重肾衰竭，平均血清肌酐为9.05±2.84mg%，77%的患者需要透析支持。17例患者完成化疗，7例失访，2例患者死亡。10例（38.5%）患者肾功能完全恢复；3例患者部分恢复且停止透析，4例患者仍依赖透析。17例接受化疗的患者中有9例骨髓瘤缓解。9例患者的肾活检结果显示：管型肾病（4例）、淀粉样变性（3例）、增殖性肾小球肾炎（1例），1例患者为管型肾病合并慢性间质性肾炎和浆细胞浸润。
急性可逆性肾衰竭是MM的常见并发症，对于中老年患者不明原因的ARF应考虑多发性骨髓瘤为病因。
