Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Adv Chronic Kidney Dis. 2012 Sep;19(5):297-302. doi: 10.1053/j.ackd.2012.06.001.
Renal impairment is a serious complication of multiple myeloma. The primary cause of renal failure in myeloma is damage to the kidney by excessive amounts of light chain produced by the myeloma tumor, giving rise to cast nephropathy (myeloma kidney), although there are several other important precipitants. Significantly poor prognosis is observed in patients who do not recover their renal function; however, with the advent of more effective therapies and a greater understanding of the pathogenesis of the underlying process, it has become possible to reverse renal impairment in greater numbers of patients. Determining whether the renal impairment is due to cast nephropathy should be the first priority, and once the diagnosis is confirmed, appropriate treatment should be initiated without delay. Reduction of serum free light chain is the key to recovery of renal function in these patients. The role of chemotherapy and extracorporeal removal of light chain are discussed.
肾功能损害是多发性骨髓瘤的严重并发症。骨髓瘤导致肾衰竭的主要原因是骨髓瘤肿瘤产生的过量轻链对肾脏造成损害，导致管型肾病（骨髓瘤肾），尽管还有其他一些重要的诱因。肾功能未恢复的患者预后明显较差；然而，随着更有效的治疗方法的出现和对潜在发病机制的更深入了解，越来越多的患者的肾功能损害得以逆转。确定肾功能损害是否由于管型肾病引起应是首要任务，一旦确诊，应立即开始适当的治疗。降低血清游离轻链是这些患者肾功能恢复的关键。本文讨论了化疗和体外去除轻链的作用。
