Knudsen L M, Hippe E, Hjorth M, Holmberg E, Westin J
Department of Internal Medicine, Herlev Hospital Copenhagen, Denmark.
Eur J Haematol. 1994 Oct;53(4):207-12. doi: 10.1111/j.1600-0609.1994.tb00190.x.
This study describes the occurrence of renal failure among 1353 newly diagnosed cases of multiple myeloma. Renal function was evaluated by serum creatinine concentration in 1353 cases, 31% of whom had renal failure at the time of diagnosis. In 1206 cases an estimation of creatinine clearance was made. When renal failure was defined by using creatinine clearance estimation, 49% had renal failure at the time of diagnosis. Renal failure was present in 24% of patients with an M component of IgG-, 31% of IgA- and 100% of IgD-type. 52% of patients with light chain disease had renal failure. The frequency of renal failure was similar in lambda- and kappa-light chain disease. Patients with a high excretion of Bence Jones protein in the urine (> 10 g/24 h) had renal failure significantly more often than patients with lower excretion. Renal failure was related to advanced disease; 41% of patients with stage III (Durie-Salmon) disease had renal failure. Renal failure was found in 45% of patients with hypercalcaemia. When estimated creatinine clearance was used as a predictor of renal function, the same trends were found as mentioned above. In addition, the proportion of patients with renal failure was found to increase with advancing age.
本研究描述了1353例新诊断的多发性骨髓瘤患者中肾衰竭的发生情况。对1353例患者通过血清肌酐浓度评估肾功能，其中31%在诊断时即有肾衰竭。对1206例患者进行了肌酐清除率估算。当采用肌酐清除率估算来定义肾衰竭时，49%的患者在诊断时即有肾衰竭。IgG型M成分患者中24%存在肾衰竭，IgA型为31%，IgD型为100%。轻链病患者中有52%存在肾衰竭。λ轻链病和κ轻链病患者肾衰竭的发生率相似。尿中本周蛋白排泄量高（>10 g/24 h）的患者比排泄量低的患者发生肾衰竭的频率明显更高。肾衰竭与疾病进展相关；Ⅲ期（Durie-Salmon分期）疾病患者中有41%存在肾衰竭。高钙血症患者中有45%发现有肾衰竭。当将估算的肌酐清除率用作肾功能的预测指标时，发现了与上述相同的趋势。此外，发现肾衰竭患者的比例随年龄增长而增加。
