Gordovskaia N B, Kravets T A, Tareeva I E
Ter Arkh. 1986;58(8):45-8.
The authors have analysed the difficulties of delayed diagnosis of multiple myeloma (MM) with renal lesion in 27 patients admitted to the clinic of therapy and occupational diseases of the I.M. Sechenov First Moscow Medical Institute over the last 10 years. Before admission to the clinic MM was presumably diagnosed in 6 patients only, 17 patients were referred to the clinic with the diagnosis of this or that renal disease, 3 with the diagnosis of hypertension and 1 with rheumatoid arthritis. The main symptom in all the patients was proteinuria (isolated or combined with raised ESR and/or anemia in scanty urinary sediment). Macrohematuria was occasionally noted in one patient at the onset of the disease, and in another patient the onset of MM was marked by tubulopathy. The correct recognition of MM with renal lesion was rare which was due to a variety of initial symptoms (sometimes they were poorly expressed) and underestimation of the diagnostic importance of the combination of proteinuria with raised ESR and/or anemia.
作者分析了过去10年在莫斯科第一谢马什克国立医科大学治疗与职业病诊所收治的27例合并肾脏损害的多发性骨髓瘤（MM）患者延迟诊断的困难情况。入院前，仅6例患者可能被诊断为MM，17例患者因各种肾脏疾病诊断被转诊至该诊所，3例诊断为高血压，1例诊断为类风湿关节炎。所有患者的主要症状均为蛋白尿（孤立出现或合并尿沉渣中血沉增快和/或贫血）。1例患者在疾病初期偶尔出现肉眼血尿，另1例患者MM起病时以肾小管病变为特征。合并肾脏损害的MM的正确诊断很少见，这是由于初始症状多样（有时表现不明显）以及对蛋白尿合并血沉增快和/或贫血的诊断重要性估计不足。
