Shi Hao, Zhang Wen, Li Xiao, Ren Hong, Pan Xiaoxia, Chen Nan
Department of Nephrology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China.
Leuk Lymphoma. 2014 May;55(5):1076-82. doi: 10.3109/10428194.2013.820284. Epub 2013 Aug 20.
Abstract Although there have been numerous studies of patients with multiple myeloma (MM) and acute kidney injury (AKI), the results from these studies have varied greatly because of inconsistent definitions of AKI. The RIFLE criteria, which were designed to standardize the staging of AKI, have been extensively validated worldwide, but rarely in patients with MM. We retrospectively analyzed the natural history of 78 patients with MM and AKI between July 1995 and December 2010. RIFLE criteria, solely on the basis of the serum creatinine standard, were applied to stage the severity of AKI as risk, injury or failure. Among patients at the risk, injury and failure stage, the chemotherapy response rates were 54.5%, 63.6% and 39.3% (p = 0.26), and the renal response rates were 72.7%, 90.9% and 30.4%, respectively (p < 0.001). Severity of AKI predicted renal response but not chemotherapy response. Older age (odds ratio [OR] = 1.04, p = 0.01), hypercalcemia (OR = 2.57, p = 0.01) and reversibility of renal insufficiency (OR = 3.35 for no vs. yes, p < 0.001) were independent prognostic factors associated with survival. Severity of AKI staged by RIFLE class (OR = 2.04, failure stage vs. risk and injury stages. p = 0.06) was associated with marginally better long-term outcome. The RIFLE criteria may play a critical role in the early prevention and management of AKI in this population.
摘要 尽管已有众多关于多发性骨髓瘤（MM）合并急性肾损伤（AKI）患者的研究，但由于AKI定义不一致，这些研究结果差异很大。旨在标准化AKI分期的RIFLE标准已在全球范围内得到广泛验证，但在MM患者中很少应用。我们回顾性分析了1995年7月至2010年12月期间78例MM合并AKI患者的自然病程。仅根据血清肌酐标准应用RIFLE标准将AKI严重程度分为风险期、损伤期或衰竭期。在处于风险期、损伤期和衰竭期的患者中，化疗缓解率分别为54.5%、63.6%和39.3%（p = 0.26），肾脏缓解率分别为72.7%、90.9%和30.4%（p < 0.001）。AKI严重程度可预测肾脏缓解，但不能预测化疗缓解。年龄较大（优势比[OR]=1.04，p = 0.01）、高钙血症（OR = 2.57，p = 0.01）和肾功能不全的可逆性（无可逆性与有可逆性的OR = 3.35，p < 0.001）是与生存相关的独立预后因素。根据RIFLE分级分期的AKI严重程度（衰竭期与风险期和损伤期相比，OR = 2.04，p = 0.06）与略好的长期结局相关。RIFLE标准可能在该人群AKI的早期预防和管理中发挥关键作用。
