Unidad de Nefrología, Complejo Hospitalario de Jaén, Spain.
Nefrologia. 2013;33(4):515-23. doi: 10.3265/Nefrologia.pre2013.Feb.11932.
Multiple myeloma (MM) is the uncontrolled proliferation of plasma cells with variable amounts of production of immunoglobulins or their chains. Acute renal failure can be a symptom of MM, and it is sometimes its form of presentation. Circulating free light chains (FLC) could lead to renal failure due to their intratubular precipitation, causing a cast nephropathy. The treatment of myeloma, adequate hydration and the removal of FLC by apheresis techniques are currently the treatments that are accepted for this disease. Several apheresis techniques have been attempted for the removal of FLC, with long haemodialysis sessions with filters for the removal of these light chains (high cut-off filters) being proposed as the most effective treatment for myeloma nephropathy.
We report 5 cases of myeloma nephropathy: three had cast nephropathy (CN) diagnosed by renal biopsy and the other two had a high probability of CN (FLC levels >500 mg/l). They were treated with long haemodialysis sessions with a high cut-off membrane. All patients had suffered acute renal failure; four required renal replacement therapy and one patient had advanced renal failure. In all patients, FLC levels were very high. They received specific treatment for myeloma in addition to high cut-off haemodialysis until they achieved FLC levels of <500 mg/l.
Four of the five patients recovered renal function, and became independent of dialysis. The progression time for myeloma from the time the first symptoms appeared varied (1-6 months). The number of treatment sessions ranged from 8-16. The patient with the longest progression time required more sessions and did not recover renal function.
Long haemodialysis sessions with high cut-off filters in addition to specific myeloma chemotherapy seems to be an effective treatment for acute renal failure due to myeloma nephropathy. The early initiation of treatment could be a determining factor for the response.
多发性骨髓瘤（MM）是浆细胞的失控性增殖，伴有免疫球蛋白或其链的不同程度产生。急性肾衰竭可能是 MM 的一个症状，且其有时为其表现形式。游离轻链（FLC）可在管腔内沉淀，导致管型肾病，从而导致肾衰竭。目前，多发性骨髓瘤的治疗、充分水化和通过血浆分离术技术去除 FLC 被认为是这种疾病的治疗方法。已经尝试了几种血浆分离术技术来去除 FLC，使用长程血液透析联合去除这些轻链的过滤器（高截留过滤器）被提出作为治疗骨髓瘤肾病的最有效方法。
我们报告了 5 例骨髓瘤肾病患者：3 例通过肾活检诊断为管型肾病（CN），另外 2 例有很高的 CN 可能性（FLC 水平>500mg/l）。他们接受了长程血液透析联合高截留膜治疗。所有患者均发生急性肾衰竭；4 例需要肾脏替代治疗，1 例患者有晚期肾衰竭。所有患者的 FLC 水平均非常高。除了高截留血液透析外，他们还接受了针对骨髓瘤的特异性治疗，直到 FLC 水平<500mg/l。
5 例患者中有 4 例恢复了肾功能，且不再需要透析。从首次出现症状到骨髓瘤进展的时间各不相同（1-6 个月）。治疗次数从 8 到 16 次不等。进展时间最长的患者需要更多的治疗次数且未能恢复肾功能。
除了针对骨髓瘤的特异性化疗外，使用高截留过滤器进行长程血液透析似乎是治疗骨髓瘤肾病引起的急性肾衰竭的有效方法。早期开始治疗可能是决定反应的一个因素。
