Iványi B
Department of Pathology, Albert Szent-Györgyi University of Medicine, Szeged, Hungary.
Acta Morphol Hung. 1989;37(3-4):235-43.
Renal complications were studied in 81 autopsied patients suffering from multiple myeloma (47 male, 34 female, mean age 66.3 years). Kidney samples were examined for the presence of Bence Jones cast nephropathy, light chain deposition disease, amyloidosis, nephrocalcinosis, chronic urate nephropathy, acute renal failure, renal vein thrombosis, acute and chronic pyelonephritis, and tumorous infiltration of the kidney tissue. Lesions were graded under the light microscope as minimal, mild, moderate or severe. This grading and the corresponding serum creatinine levels were used to distinguish four groups: 1. morphologically and functionally intact kidney (40 cases); 2. kidney involvement with good renal function (10 cases); 3. kidney involvement with moderate chronic renal insufficiency (16 cases); 4. kidney involvement with chronic uraemia (15 cases). In patients with an impaired renal function (groups 3 and 4), Bence Jones cast nephropathy occurred most frequently (27 cases, 33%); all other complications were seen much less frequently. Among the 81 patients, two cases of kappa light chain deposition disease and three cases of amyloidosis were found. Although the semiquantitative morphology and serum creatinine levels displayed a good correlation, there were cases with marked histological changes but only a moderate impairment in renal function, suggesting that the drawing of functional conclusions from morphological changes of the kidney requires caution.
对81例多发性骨髓瘤尸检患者（47例男性，34例女性，平均年龄66.3岁）的肾脏并发症进行了研究。检查肾脏样本，以确定是否存在本-周蛋白管型肾病、轻链沉积病、淀粉样变性、肾钙质沉着症、慢性尿酸盐肾病、急性肾衰竭、肾静脉血栓形成、急性和慢性肾盂肾炎以及肾脏组织的肿瘤浸润。在光学显微镜下将病变分为轻度、中度或重度。这种分级以及相应的血清肌酐水平被用于区分四组：1. 形态和功能正常的肾脏（40例）；2. 肾功能良好的肾脏受累（10例）；3. 伴有中度慢性肾功能不全的肾脏受累（16例）；4. 伴有慢性尿毒症的肾脏受累（15例）。在肾功能受损的患者（第3组和第4组）中，本-周蛋白管型肾病最为常见（27例，33%）；所有其他并发症的发生率则低得多。在这81例患者中，发现了2例κ轻链沉积病和3例淀粉样变性。虽然半定量形态学和血清肌酐水平显示出良好的相关性，但仍有一些病例组织学变化明显但肾功能仅中度受损，这表明从肾脏形态学变化得出功能结论时需要谨慎。
