骨髓瘤管型肾病合并药物相关急性间质性肾炎2例及文献复习

Myeloma Cast Nephropathy Complicated with Drug-Induced Acute Interstitial Nephritis:2 Case Reports and Literature Review

目的探讨骨髓瘤管型肾病合并药物相关急性间质性肾炎的临床病理特点及诊断。方法回顾性分析2例骨髓瘤管型肾病合并药物相关急性间质性肾炎患者的临床资料,并复习相关文献。结果2例患者均在服用药物后出现急性肾衰竭,肾活检病理符合急性间质性肾炎的特点,同时发现较多管型,免疫荧光染色管型λ轻链阳性强度呈显著优势,在完善游离轻链测定、骨髓穿刺活检等检查后,明确了多发性骨髓瘤、骨髓瘤管型肾病合并药物相关急性间质性肾炎诊断。结论多发性骨髓瘤早期症状可不典型,患者易受药物等因素的影响而加重肾脏损害,肾活检可以为诊断提供重要信息,避免误诊和漏诊。

Objective To investigate the clinicopathological characteristics and diagnosis of myeloma cast nephropathy complicated with drug-induced acute interstitial nephritis.Methods The clinical features of 2 patients with myeloma cast nephropathy complicated with drug-induced acute interstitial nephritis were analyzed retrospectively and the relevant literatures were reviewed.Results Both patients developed acute renal failure after taking drugs.Characteristics of acute interstitial nephritis were evident by renal pathology.In the meantime,many casts were found in the renal tissue,which were predominantlyλlight chain positive by immunofluorescence staining.The diagnosis of multiple myeloma and cast nephropathy with drug-induced acute interstitial nephritis was further confirmed by the free light chain measurement and bone marrow biopsy.Conclusion The early symptoms of patients with multiple myeloma may be atypical,and the diseased kidneys are susceptible to being aggravated by drugs and other factors.Kidney biopsy is indispensable for diagnosis and helps clinicians avoid misdiagnosis and missed diagnosis.