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目的探讨多发性骨髓瘤肾损害患者的临床表现、早期诊断及其治疗效果。方法对我院19例以肾脏损害为首发的多发性骨髓瘤患者的临床资料进行回顾性分析。结果所有患者均有不同程度的贫血(血红蛋白55～94g/L)及肾脏损害:尿蛋白(+～)伴肾衰竭(血清肌酐142～1328μmol/L)。其中6例(31.5%)高钙血症,11例(57.9%)高尿酸血症;,9例(47.3%)高球蛋白血症,6例(31.5%)异常M蛋白,3例(15.8%)溶骨性破坏或骨质疏松。确诊后有2例患者中断、放弃治疗,其余经综合治疗后5例(26.3%)完全缓解,6例需依赖血液透析。结论多发性骨髓瘤肾损害临床表现复杂,对中老年表现为贫血,蛋白尿及肾衰竭患者应考虑该病的可能,完善骨髓穿刺或肾活检术,确诊后有效的化疗,输液、利尿,积极治疗高钙血症、感染及高尿酸血症,血液透析等,可延缓肾损害的进展,改善预后。
Objective To investigate the clinical manifestations, early diagnosis and treatment of multiple myeloma patients with renal damage. Methods A retrospective analysis was performed on the clinical data of 19 patients with multiple myeloma who had renal damage. Results All patients had different degrees of anemia (hemoglobin 55 ~ 94g / L) and renal damage: urinary protein (+ ~) with renal failure (serum creatinine 142 ~ 1328μmol / L). Six cases (31.5%) had hypercalcemia, 11 cases (57.9%) had hyperuricemia, 9 cases (47.3%) had hypergammaglobulinemia, 6 cases (31.5%) had abnormal M protein and 3 cases %) Osteolytic destruction or osteoporosis. After the diagnosis, 2 patients were interrupted and the treatment was abandoned. The remaining 5 patients (26.3%) after complete treatment were completely relieved, and 6 patients were required to rely on hemodialysis. Conclusions The clinical manifestations of multiple myeloma and renal damage are complex. Patients with anemia, proteinuria and renal failure in middle-aged and elderly patients should consider the possibility of the disease. Perfecting bone marrow biopsy or renal biopsy, effective chemotherapy, infusion and diuretic diagnosis after active diagnosis Treatment of hypercalcemia, infection and hyperuricemia, hemodialysis, etc., can delay the progression of renal damage and improve prognosis.