22例不典型多发性骨髓瘤并肾损害的临床分析

Clinical analysis of 22 cases of atypical multiple myeloma complicated with renal involvement

目的探讨不典型多发性骨髓瘤肾损害早期诊断的线索。方法对以肾损害为首发表现收治于我院肾内科的22例多发性骨髓瘤（multiple myeloma，MM）肾损害患者的临床资料进行回顾性分析。结果22例患者均以肾损害为首发表现，并无明显的骨髓瘤全身症状，其中10例以蛋白尿为首发表现，12例以肾功能不全为首发表现。贫血者16例，其中8例贫血程度与肾功能水平明显不平行；高尿酸血症者10例，其中6例与肾功能不平行；高钙血症者3例、高球蛋白血症者11例、红细胞沉降率（ESR）明显增快者7例、24h尿白蛋白在总蛋白中所占比例〈50％者6例；肾脏B超提示双肾均无明显缩小。结论探讨MM。肾损害的早期诊断线索对提高其诊断水平和及时的治疗均有重要的意义。

Objective To explore the early diagnostic clues of atypical multiple myeloma （MM） with renal involvement. Method Clinical features of 22 MM patients which initially manifested hy renal damage in our hospital were analyzed retrospectively. Result All 22 MM patients presented as renal damage without obvious constitutional symptom of MM： 10 patients presented as proteinuria and 12 patients presented as renal insufficiency. Sixteen cases had anemia, but the degree of anemia and renal function were not parallel in 8; Ten cases had hyperurieemia, but the degree of uric acid and renal function were not parallel in 6; Three cases had hypercalcinemia; Eleven cases had hyperglobulitlemia; Seven cases had markedly elevated ESR level; 24 h urinary albumin in 6 cases were not more than 50 percents of total protein; All cases were identified with a normal sized kidney by B-ultrasound. Conclusion Exploring the early diagnostic clues of MM has a great value in the early diagnosis and the prompt treatment of atypical MM with renal involvement.