Mackenzie M R, Wuepper K D, Jordan G, Fudenberg H H
Clin Exp Immunol. 1968 Jul;3(6):593-601.
The rapid onset of subacute renal failure in a patient without prior known kidney disease prompted the present study. A renal biopsy specimen showed the characteristic pathological changes of `myeloma kidney', including deposition of proteinaceous material in the lumen of the proximal tubules. Cellulose-acetate electrophoresis of the patient's serum failed to indicate any protein abnormalities, although Bence Jones proteinaemia was readily demonstrated by agar-gel electophoresis. In immunofluorescence studies of kidney tissue obtained , the region of the tubular basement membrane reacted positively with anti-kappa antiserum and with antiserum to Bence Jones protein isolated from the patient's serum. The material occluding the tubular lumens, however, failed to stain with either antiserum. The occurrence of acute or subacute renal failure in patients with multiple myeloma has been attributed to occlusion of the renal tubules by deposits of Bence Jones proteins. The data obtained in this study indicate the need for re-examining this concept.
一名既往无已知肾脏疾病的患者迅速出现亚急性肾衰竭，促使开展了本研究。肾活检标本显示出“骨髓瘤肾病”的特征性病理变化，包括近端小管管腔内有蛋白质物质沉积。患者血清的醋酸纤维素电泳未显示任何蛋白质异常，尽管琼脂凝胶电泳很容易检测出本周氏蛋白尿血症。在对获取的肾组织进行免疫荧光研究时，肾小管基底膜区域与抗κ抗血清以及从患者血清中分离出的本周氏蛋白抗血清呈阳性反应。然而，阻塞肾小管管腔的物质未被任何一种抗血清染色。多发性骨髓瘤患者出现急性或亚急性肾衰竭一直被归因于本周氏蛋白沉积物阻塞肾小管。本研究获得的数据表明有必要重新审视这一概念。
