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本文分析了11例多发性骨髓瘤(MM)伴肾脏损害的临床特点,结合7例患者肾活检病理及免疫病理检查,分析 MM 所致的肾脏病变.结果发现,10例患者在确定诊断时已为病程Ⅲ期,5例患者已经发展至不可逆的终末期肾衰,其余患者均有不同程度肾功能损害,87.5%患者尿中存在游离轻链。肾脏以肾小管-间质病变为主,伴或不伴管型形成,肾小球仅有系膜增生,免疫酶标检查可见轻链在管型、肾小管基膜,甚至肾小球内沉积。本文结果表明,对不明原因肾小管间质损害的患者,特别是老年肾病综合征患者,必须排除 MM,直接测定尿轻链有助于诊断。
This article analyzes the clinical features of 11 cases of multiple myeloma (MM) with renal damage, combined with renal biopsy pathology and immunopathological examination of 7 patients, analysis of MM-induced renal lesions.Results found that 10 patients in the diagnosis of For the course of disease Ⅲ, 5 patients have developed to irreversible end-stage renal failure, the rest of patients have varying degrees of renal dysfunction, 87.5% of patients with free light chain in the urine. Kidney to tubulointerstitial lesions, with or without the formation of tubular, mesangial proliferative only glomerular, immune enzyme test showed visible light chain in the tubular, tubular basement membrane, and even glomerular deposition . Our results show that, for patients with unexplained tubulointerstitial damage, especially in patients with senile nephrotic syndrome, you must rule out MM, direct determination of urine light chain is helpful in the diagnosis.