Department of Nephrology, CHU and Université de Poitiers, Department of Hematology and Immunology, Hôpital Saint Louis, Paris, France.
Adv Chronic Kidney Dis. 2012 Sep;19(5):333-41. doi: 10.1053/j.ackd.2012.07.003.
Renal failure is a frequent complication of multiple myeloma (MM) that strongly affects patient survival. Although a variety of renal diseases may be observed in MM, myeloma cast nephropathy (MCN), a tubulo-interstitial disorder related to precipitation of a monoclonal light chain (LC) within tubular distal lumens, is the main cause of severe and persistent renal failure. To date, the respective frequency and initial evolution of renal disorders associated with monoclonal LC in MM remain poorly defined. Treatment of MCN relies on urgent symptomatic measures and rapid introduction of chemotherapy to reduce the production of monoclonal LC. The introduction of novel chemotherapy regimens based on the association of bortezomib with dexamethasone is likely to have improved the prognosis of MM patients with renal failure. In addition, the combination of novel agents with efficient removal of circulating LC through high cut-off hemodialysis membrane may further increase renal response rate. However, the impact on patient and renal outcomes of these potential therapeutic advances has not been evaluated in prospective studies. The randomized trials EuLITE in the UK and Germany and MYRE in France should help to answer these issues. MYRE is a randomized controlled phase III trial (NCT01208818) that aims to better define the epidemiology and typology of inaugural renal failure in MM and to optimize therapy of MCN patients with and without dialysis-dependent renal failure.
肾衰竭是多发性骨髓瘤（MM）的常见并发症，严重影响患者的生存。尽管在 MM 中可能观察到多种肾脏疾病，但骨髓瘤管型肾病（MCN）是一种与单克隆轻链（LC）在管状远端管腔中沉淀有关的小管间质性疾病，是导致严重和持续肾衰竭的主要原因。迄今为止，与 MM 中单克隆 LC 相关的肾脏疾病的各自频率和初始演变仍未得到明确界定。MCN 的治疗依赖于紧急对症治疗和迅速引入化疗以减少单克隆 LC 的产生。基于硼替佐米联合地塞米松的新型化疗方案的引入，可能改善了肾衰竭 MM 患者的预后。此外，通过高通量血液透析膜有效清除循环 LC 的新型药物联合使用，可能进一步提高肾脏缓解率。然而，这些潜在治疗进展对患者和肾脏结局的影响尚未在前瞻性研究中进行评估。英国和德国的 EuLITE 以及法国的 MYRE 随机试验有望回答这些问题。MYRE 是一项随机对照 III 期试验（NCT01208818），旨在更好地定义 MM 首发肾衰竭的流行病学和类型学，并优化有和无透析依赖性肾衰竭的 MCN 患者的治疗。
