切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 195 -199. doi: 10.3877/cma.j.issn.2095-3216.2017.05.002

所属专题: 文献

述评

多发性骨髓瘤肾损害的诊疗进展
毛永辉1,(), 王松岚1   
  1. 1. 100005 北京医院肾内科
  • 收稿日期:2017-10-01 出版日期:2017-10-28
  • 通信作者: 毛永辉
  • 基金资助:
    首都临床特色应用研究与成果推广(Z151100004015083)

Progress in diagnosis and treatment of multiple myeloma patients with renal impairment

Yonghui Mao1,(), Songlan Wang1   

  1. 1. Department of Nephrology, Beijing Hospital, Beijing 100005, China
  • Received:2017-10-01 Published:2017-10-28
  • Corresponding author: Yonghui Mao
  • About author:
    Corresponding author: Mao Yonghui, Email:
引用本文:

毛永辉, 王松岚. 多发性骨髓瘤肾损害的诊疗进展[J]. 中华肾病研究电子杂志, 2017, 06(05): 195-199.

Yonghui Mao, Songlan Wang. Progress in diagnosis and treatment of multiple myeloma patients with renal impairment[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2017, 06(05): 195-199.

多发性骨髓瘤(MM)是指骨髓中浆细胞异常增生所引起的恶性增殖性疾病,其以产生单克隆免疫球蛋白或其片段为特征,进而导致相关器官或组织损害。肾损害是多发性骨髓瘤的常见并发症,且是其主要的致死原因之一。骨髓瘤肾损害发生机制多样,管型肾病和高钙血症是最主要原因。及时有效的诊断并采取适当治疗可改善这类患者总体预后。本文重点阐述骨髓瘤相关性肾损害的诊疗进展。

Multiple myeloma (MM) refers to a malignant proliferative disorder caused by abnormal proliferation of plasma cells in the bone marrow, which is characterized by the production of monoclonal immunoglobulins or their fragments that subsequently lead to damage to the relevant organs or tissues. Renal damage is a common complication of MM, and is one of the main causes of death. There are various mechanisms of renal damage in MM, among which tubular nephropathy and hypercalcaemia are most important. Timely and effective diagnosis and appropriate treatment plans can improve the overall prognosis of such patients. This article focused on the diagnosis and treatment of myeloma-related renal damage.

图1 筛查管型肾病的流程
[1]
Kariyawasan CC, Hughes DA, Jayatillake MM, et al. Multiple myeloma: causes and consequences of delay in diagnosis [J]. QJM, 2007, 100(10): 635-639.
[2]
Knudsen LM, Hippe E, North M, et al. Renal function in newly diagnosed multiple myeloma-a demographic study of 1353 patients. [J]. Eur J Haematol, 1994, 53(4): 207-212.
[3]
Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma [J]. Mayo Clin Proc, 2003, 78(1): 21-24.
[4]
Gonsalves WI, Leung N, Rajkumar SV, et al. Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma [J]. Blood Cancer J, 2015, 5(3): e296-e311.
[5]
Hutchison CA, Plant T, Drayson M, et al. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure [J]. BMC Nephrol, 2008, 9: 11-19.
[6]
Dispenzieri A, Kyle R, Merlini G, et al.International Myeloma Working Group guidelines for serum free light chain analysis in multiple myeloma and related disorders [J]. Leukemia, 2009, 23(2): 215-224.
[7]
Hutchison CA, Plant T, Drayson M, et al. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure [J]. BMC Nephrol, 2008, 9: 11-20.
[8]
Hutchison CA, Harding S, Hewins P, et al. Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease [J]. Clin J Am Soc Nephrol, 2008, 3(6): 1684-1690.
[9]
Heher EC, Rennke HG, Laubach JP, et al. Kidney disease and multiple myeloma [J]. Clin J Am Soc Nephrol, 2013, 8(11): 2007-2017.
[10]
Basnayake K, Ying WZ, Wang PX, et al. Immunoglobulin light chains activate tubular epithelial cells through redox signaling [J]. J Am Soc Nephrol, 2010, 21(7): 1165-1173.
[11]
Kleber M, Ihorst G, Deschler B, et al. Detection of renal impairment as one specific comorbidity factor in multiple myeloma: multicenter study in 198 consecutive patients [J]. Eur J Haematol, 2009, 83(6): 519-527.
[12]
Cockwell P, Hutchison CA. Management options for cast nephropathy in multiple myeloma [J]. Curr Opin Nephrol Hypertens, 2010, 19(6): 550-555.
[13]
Munier A, Gras V, Andrejak M, et al. Zoledronic acid and renal toxicity: data from French adverse effect reporting database [J]. Ann Pharmacother, 2005, 39(7-8): 1194-1197.
[14]
Hiromura K, Nujima Y. Renal disease in multiple myeloma [J]. Nihon Rinsho, 2007, 65(12): 2229-2234.
[15]
Barlogie B, Shaughnessy J, Tricot S, et al. Treatment of multiple myeloma [J]. Blood, 2004, 103(1): 20-22.
[16]
Ludwig H, Adam Z, Hajek R, et al. Light chain-induced acute renal failure can be reversed by bortezomib-doxorubicin -dexamethasone in multiple myeloma: results of a phase II study [J]. J Clin Oncol, 2010, 28(30): 4635-4642.
[17]
Sonneveld P, Schmidt-Wolf IG, van der Holt B, et al. Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase Ⅲ HOVON-65/ GMMG-HD4 trial [J]. J Clin Oncol, 2012, 30(24): 2946-2956.
[18]
Ballester OF, Tummala R, Janssen WE, et al. High-dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with multiple myeloma and renal insufficiency [J]. Bone Marrow Transplant, 1997, 20(8): 653-666.
[19]
何东,牛挺.硼替佐米治疗多发性骨髓瘤的应用进展[J].华西医学,2012,(2): 197-202.
[20]
Dimopoulos MA, Moreau P, Palumbo A, et al. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3,open-label,multicentre study [J]. Lancet Oncol, 2016, 17(1): 27-38.
[21]
Assi LK, McIntyre N, Fraser S, et al. The association between polyclonal combined serum free light chain concentration and mortality in individuals with early chronic kidney disease [J]. PLoS One, 2015, 10(7): e0129980.
[22]
Hutchison CA, Cockwell P, Reid S, et al. Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies [J]. J Am Soc Nephrol, 2007, 18(3): 886-895.
[23]
Tanner GA, Evan AP, Summerlin PB, et al. Glomerular and proximal tubular morphology after single nephron obstruction [J]. Kidney Int, 1989, 36(6): 1050-1060.
[24]
Leung N, Gertz MA, Zeldenrust SR, et al. Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains [J]. Kidney Int, 2008, 73(11): 1282-1288.
[25]
Yu X, Gan L, Wang Z, et al. Chemotherapy with or without plasmapheresis in acute renal failure due to multiple myeloma:a meta-analysis [J]. Int J Clin Pharmacol Ther, 2015, 53(5): 391-397.
[26]
Hutchison CA, Bradwell AR, Cook M, et al. Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis [J]. Clin J Am Soc Nephrol, 2009, 4(4): 745-754.
[27]
Hutchison CA, Cockwell P, Reid S. et al. Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies [J]. J Am Soc Nephrol, 2007, 18(3): 886-895.
[28]
Martín-Reyes G, Toledo-Rojas R, Torres-de R, et al. Haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma [J]. Nefrologia (Madr), 2012, 32: 35-43.
[29]
Hutchison CA, Heyne N, Airia P, et al. Immunoglobulin free light chain levels and recovery from myeloma kidney on treatment with chemo therapy and high cut-off haemodialysis [J].Nephrol Dial Transplant, 2012, 27(10): 3823-3828.
[30]
Curti A, Schwarz A, Trachsler J, et al. Therapeutic efficacy and cost effectiveness of high cut-off dialyzers compared to conventional dialysis in patients with cast nephropathy [J]. PLoS One, 2016, 11(7): e0159942.
[31]
Grima DT, Airia P, Attard C, et al. Modelled cost-effectiveness of high cut-off haemodialysis compared to standard haemodialysis in the management of myeloma kidney [J]. Curr Med Res Opin, 2011, 27(2): 383-391.
[32]
Hutchison CA, Cook M, Heyne N, et al. European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): a randomised control trial [J]. Trials, 2008, 9: 55.
[33]
Cook M, Hutchison C, Fifer L, et al. High cut-off haemodilysis (HCO-HD)dose not improve outcomes in myeloma cast nephropathy: results of European trial of free light chain removal by extended haemodilysis in cast nephropathy (EULITE) [J]. Adv Chronic Kidney Dis, 2012, 19(5): 333-341.
[34]
Taheri D, Chehrei A, Fesharakizadeh M, et al. Recurrent multiple myeloma following renal transplantation: a case report [J]. Transplant Proc, 2007, 39(4): 1063-1065.
[35]
Spitzer TR, Sykes M, Tolkoff-Rubin N, et al. Long-term follow up of recipients of combined human leukocyte antigen-matched bone marrow and kidney transplantation for multiple myeloma with end-stage renal disease [J]. Transplantation, 201l, 91(6): 672-676.
[1] 刘梅, 孙菊, 吴迪炯, 俞庆宏, 刘文宾, 胡慧瑾, 叶宝东. 尿多酸肽通过调节caspase家族诱导多发性骨髓瘤细胞U266凋亡的实验研究[J]. 中华危重症医学杂志(电子版), 2018, 11(04): 256-259.
[2] 路炳通, 侯英荣, 胡永强, 齐雅欣. 血清乳酸脱氢酶、白细胞介素6、降钙素原和超敏C反应蛋白水平变化在多发性骨髓瘤合并细菌感染者预后中的评估价值[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 187-193.
[3] 陈瑜, 尤良顺, 孟海涛, 杨敏. 嵌合抗原受体T细胞治疗多发性骨髓瘤新进展[J]. 中华移植杂志(电子版), 2023, 17(05): 313-320.
[4] 何静松, 张恩帆, 赵毅, 杨杨, 何冬花, 韩晓雁, 郑高锋, 陈晶晶, 罗依, 施继敏, 黄河, 蔡真. 自体造血干细胞移植治疗髓外多发性骨髓瘤疗效分析[J]. 中华移植杂志(电子版), 2021, 15(02): 93-100.
[5] 梁嘉华, 曹家栋, 王树声. 孤立性膀胱浆细胞瘤的病例分析及文献复习[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(01): 60-64.
[6] 顾鹏, 何晓亮. 前列腺癌合并多发性骨髓瘤一例报告[J]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(01): 79-80.
[7] 周艳群, 陈鹏, 刘增慧, 毛晶晶, 黎耀和. 多发性骨髓瘤患者骨髓间充质干细胞衰老关键基因和通路的生物信息学分析与验证[J]. 中华细胞与干细胞杂志(电子版), 2022, 12(05): 274-281.
[8] 刘一, 文旖旎, 吴映辉. 过敏性紫癜患儿外周血辅助性T细胞、调节性T细胞细胞因子与肾损害的相关性分析[J]. 中华肾病研究电子杂志, 2023, 12(05): 271-275.
[9] 陈艺勤, 胡晓璇, 侯海晶, 古月瑜, 刘旭生, 卢富华. 抗中性粒细胞胞浆抗体相关性血管炎肾损害的免疫炎症机制研究进展[J]. 中华肾病研究电子杂志, 2022, 11(02): 104-108.
[10] 赵朵, 刘赛磊, 李静. 血浆置换联合激素或/和免疫抑制剂治疗ANCA相关性小血管炎严重肾损害临床疗效和预后的Meta分析[J]. 中华肾病研究电子杂志, 2020, 09(02): 67-73.
[11] 张婷, 刘寻, 王晓菲, 逯小英, 邹洪斌. 内皮素与高血压肾损害的关系研究进展[J]. 中华肾病研究电子杂志, 2019, 08(06): 273-276.
[12] 鲁盈, 傅文宁. 系统性小血管炎肾损害的中医病因病机与中西医结合治疗[J]. 中华肾病研究电子杂志, 2019, 08(04): 155-158.
[13] 苏杰, 杨小静, 周雪. HSP27介导多发性骨髓瘤细胞诱导硼替佐米耐药的机制研究[J]. 中华临床医师杂志(电子版), 2021, 15(10): 779-784.
[14] 郝冬冬, 李平, 张颖, 梁成通, 刘昌华, 徐道亮. 高截留量血液透析对维持性血液透析患者血清超敏C反应蛋白、白介素6、白介素12及肿瘤坏死因子α的清除作用[J]. 中华临床医师杂志(电子版), 2020, 14(09): 704-708.
[15] 金炜, 管俊, 陈家楠, 许荟. 多发性骨髓瘤骨病发病机制及治疗的研究进展[J]. 中华临床医师杂志(电子版), 2018, 12(11): 630-634.
阅读次数
全文


摘要