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多发性骨髓瘤(MM)是一种单克隆浆细胞异常增生恶性疾病,肾损害是MM常见和严重的并发症之一,但由于MM肾损害临床表现复杂多样,起病隐匿,误、漏诊率高。本例MM肾损害早期症状、血清免疫球蛋白变化及肾脏病理表现不典型,误诊为亚急性肾间质肾炎。结合相关文献及本例患者,对于MM肾损害早期,患者应及时行血尿固定蛋白电泳、尿轻链蛋白检测及骨髓穿刺,可以提高MM早期检出率。另外,如肾脏病理提示肾脏蛋白管型为嗜酸性、黏稠呈层板状,需要高度警惕MM肾损害,及时行骨髓穿刺明确诊断,积极化疗,降低病死率。
Multiple myeloma (MM) is a monoclonal plasma cell dysplasia malignant disease, renal damage is one of the common and serious complications of MM, but due to the complex and diverse clinical manifestations of MM nephropathy, occult onset, error, misdiagnosis rate high. In this case MM early symptoms of kidney damage, serum immunoglobulin changes and renal pathology showed atypical misdiagnosed as subacute renal interstitial nephritis. Combined with the relevant literature and patients in this case, early MM renal injury, patients should promptly hematuria gel electrophoresis, urinary light chain protein detection and bone marrow puncture, can increase the early detection rate of MM. In addition, renal pathology prompted renal tubular proteinosis is eosinophilic, viscous layered, need to be highly vigilant MM kidney damage, timely diagnosis of bone marrow puncture, aggressive chemotherapy, reduce mortality.