骨髓瘤相关性肾脏损伤的诊治进展

Progress in the diagnosis and treatment of myeloma-associated renal injury

肾脏损害是血液肿瘤常见的并发症,肾功能与患者的生活质量以及肿瘤预后密切相关。由于化疗药物的肾毒性、肿瘤本身分泌的毒性物质以及患者本身脱水、感染等情况,大部分患者的肾功能都是不可逆的。但随着研究的不断深入,对肾损伤机制的更多了解和各种低肾毒性新型药物的出现,患者的肾功能有望好转,甚至恢复到正常水平。同时肾功能的恢复对肿瘤的预后也大有裨益。多发性骨髓瘤与其他血液肿瘤有所不同,它分泌过多的游离轻链与远曲小管中Tamm-Horsfall蛋白结合形成管型,沉积于肾脏中引起管型肾病从而造成肾损伤。最新的治疗进展表明一般化疗方法结合血液净化治疗对于骨髓瘤肾病有较好的疗效,并且相对于其他血液疾病,骨髓瘤相关性肾病有更好的预后。

Renal injury is a common complication of hematologic tumor and renal function is closely related to the quality of life and prognosis in these patients.Due to nephrotoxicity of chemotherapy drugs,toxic substances produced by tumors,dehydration and infection complications,the renal injury is irreversible in most patients.However,with the advances of research,better comprehension of the renal injury mechanism and application of various new drugs with low nephrotoxicity,this renal injury is expected to be improved,or to be reversed to normal level in some cases.The improvement of renal function is of great benefit to the prognosis of tumors.Meanwhile,multiple myeloma differs from other hematologic tumors in that it secretes excessive free light chains that bind to the Tamm-Horsfall protein in distal convoluted tubules to form casts,which deposit in kidney resulting in cast nephropathy and renal injury.Recent advances in management indicate that chemotherapy combined with blood purification have a better effect on myeloma nephropathy,even better than the renal injuries in other related hematological diseases.