摘要
目的 了解多发性骨髓瘤 (MM)肾损害患者临床病理特征。方法 回顾性分析经临床、病理明确诊断的 2 4例MM肾损害患者的临床病理特征。结果 MM肾损害的临床症候群以肾功能不全 (血肌酐 >177μmol/L)最为常见 (83.3% ) ,其次为肾病综合征 (12 .5 % )、无症状尿检异常 (4.17% )。病理改变以管型肾病最为常见(6 2 .0 % ,13/ 2 1例 ) ,慢性间质性肾炎、轻链沉积病、肾小球淀粉样变性和肾小球系膜增生性病变的发生率分别为14 .3% ,9.5 2 % ,9.5 2 %和 4 .76 %。血清轻链阳性率为 6 8.4 % (13/ 19例 ) ,尿中轻链阳性率为 70 .0 % (14 / 2 0例 ) ,以λ链为主。肾组织κ、λ轻链阳性检出率为 82 .3% (14 / 17例 )。管型肾病 (13例 )较非管型肾病患者 (8例 )肾功能不全更为常见 (10 0 %vs 6 2 .5 % ,P <0 .0 5 )、本 周氏蛋白阳性率更高 (5 3.8%vs 13.5 % ,P <0 .0 5 )、小管间质病变更重 (重度小管间质病变发生率 76 .9%vs 2 5 .0 % ,P <0 .0 5 )。结论 MM伴肾损害患者临床症候群以肾功能不全多见 ,病理主要表现为管型肾病。血清与尿液中轻链以λ为主。MM伴肾损害。
Objective To analyze the clinical and histopathological features of 24 cases of multiple myeloma (MM) with renal involvement. Methods From January 1991 to March 2001, 24 patients with MM were diagnosed in the Research Institute of Nephrology of Jinling Hospital (Nanjing, China). Renal biopsies were done in 21 of them. The clinical and pathological features of this group of patients were analyzed . Results In these 24 patients, renal insufficiency (SCr>177.0 μmol/L) was the most frequent syndrome (83.3%), followed by nephrotic syndrome (12.5%) and syndrome of urinary abnormalities (4.17%). The incidences of hypertension, heavy proteinuria (≥3.5g/24h), end stage of renal failure (SCr>452 μmol/L)and hyperglobulinemia (>30.0g/L) were 20.8%, 41.7%, 62.5% and 37.5%,respectively. Cast nephropathy was the most frequent pathologic type (62.0%), followed by chronic tubulo interstitial nephritis (14.3%), light chain deposition disease (9.52%), glomerular amyloidosis (9.52%) and mesangial proliferative lesion (4.76%). Free light chain was detected in serum of 13 (13/19) patients, in urine of 14 (14/20)patients, with λ chain as the dominant type. Free light chain was also found in renal tissue of 14 (14/17) patients. Renal failure was significantly higher (100% vs 62.5%, P<0.05), B J proteinuria and severe tubulo interstitial lesion were significantly more frequent (53.8% vs 12.5%, P<0.05; 76.3% vs 25.0%, P<0.05,respectively) in 13 patients with cast nephropathy than those in other 8 patients with non cast nephropathy. Conclusions The most frequent clinical syndrome of MM with renal lesion is renal insufficiency. Cast nephropathy is the most frequent pathological type. The clinical manifestations and pathological changes of MM patients with renal lesion and cast nephropathy have some common features.
出处
《中华老年多器官疾病杂志》
2003年第1期21-26,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
