Nephrology Division and Transplantation Center, Massachusetts General Hospital, Boston, Massachusetts;, †Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, ‡Jerome Lipper Multiple Myeloma Center, Division of Hematologic Malignancy, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
Clin J Am Soc Nephrol. 2013 Nov;8(11):2007-17. doi: 10.2215/CJN.12231212. Epub 2013 Jul 18.
Kidney injury is a common complication of multiple myeloma and other plasma cell dyscrasias, and it is associated with increased mortality. Multiple pathogenic mechanisms can contribute to kidney injury in the patient with myeloma, some of which are the result of nephrotoxic monoclonal Ig and some of which are independent of paraprotein deposition. The pathogenic mechanisms that underlie paraprotein-related kidney disease are increasingly well understood. A novel assay allowing the quantification of free light chains in the serum has aided the diagnosis of new onset disease and allowed for the earlier detection of relapse. Novel myeloma agents have shown considerable promise in reversing renal failure in some patients and improving outcomes. Stem cell transplantation remains a mainstay of management for younger patients with myeloma who are suitable candidates for intensive therapy, whereas the role of new drugs, plasma exchange, and kidney transplantation continues to evolve.
肾脏损伤是多发性骨髓瘤和其他浆细胞异常的常见并发症，与死亡率增加相关。多发性骨髓瘤患者的肾脏损伤可能由多种发病机制引起，其中一些与肾毒性单克隆免疫球蛋白有关，而另一些则与副蛋白沉积无关。导致与副蛋白相关的肾脏病的发病机制已越来越被理解。一种新的检测方法可以定量检测血清中的游离轻链，有助于诊断新发病例，并更早地发现复发。新型骨髓瘤药物在一些患者逆转肾衰竭和改善预后方面显示出很大的希望。对于适合强化治疗的年轻骨髓瘤患者，干细胞移植仍然是治疗的主要手段，而新型药物、血浆置换和肾移植的作用仍在不断发展。
