Katagiri Daisuke, Noiri Eisei, Hinoshita Fumihiko
Department of Nephrology and Endocrinology, University Hospital, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan.
ScientificWorldJournal. 2013 Oct 27;2013:487285. doi: 10.1155/2013/487285. eCollection 2013.
Multiple myeloma (MM) has a high incidence rate in the elderly. Responsiveness to treatments differs considerably among patients because of high heterogeneity of MM. Chronic kidney disease (CKD) is a common clinical feature in MM patients, and treatment-related mortality and morbidity are higher in MM patients with CKD than in patients with normal renal function. Recent advances in diagnostic tests, chemotherapy agents, and dialysis techniques are providing clinicians with novel approaches for the management of MM patients with CKD. Once reversible factors, such as hypercalcemia, have been corrected, the most common cause of severe acute kidney injury (AKI) in MM patients is tubulointerstitial nephropathy, which results from very high circulating concentrations of monoclonal immunoglobulin free light chains (FLC). In the setting of AKI, an early reduction of serum FLC concentration is related to kidney function recovery. The combination of extended high cutoff hemodialysis and chemotherapy results in sustained reductions in serum FLC concentration in the majority of patients and a high rate of independence from dialysis.
多发性骨髓瘤（MM）在老年人中发病率较高。由于MM的高度异质性，患者对治疗的反应差异很大。慢性肾脏病（CKD）是MM患者常见的临床特征，与肾功能正常的患者相比，合并CKD的MM患者治疗相关的死亡率和发病率更高。诊断测试、化疗药物和透析技术的最新进展为临床医生管理合并CKD的MM患者提供了新方法。一旦高钙血症等可逆因素得到纠正，MM患者严重急性肾损伤（AKI）最常见的原因是肾小管间质性肾病，这是由循环中极高浓度的单克隆免疫球蛋白游离轻链（FLC）引起的。在AKI情况下，血清FLC浓度的早期降低与肾功能恢复有关。延长的高通量血液透析与化疗相结合，可使大多数患者的血清FLC浓度持续降低，并提高摆脱透析的比例。
