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骨髓瘤肾病是多发性骨髓瘤的严重并发症之一,其死亡率仅次于感染。多发性骨髓瘤中肾病发生率约66%,男略多于女,年龄多在50岁以上。骨髓瘤肾病可在确诊骨髓瘤前一段时间发生,因而易误诊为原发性肾病,应引起注意。一、骨髓瘤肾病的发生与下列因素有关:1.轻链的肾毒作用:骨髓瘤细胞可产生大量免疫球蛋白,其中轻链分子量小,能经肾小球滤过,进入肾小管内形成管型,阻塞管腔,从而降低GFR。此外轻链可直接损害肾脏,高等电点轻链易引起肾脏损害;轻链糖化作用和聚合作用也可损害肾脏;轻链还可促进Tamm-Horsfall 蛋白(THP)沉淀形成管型,且THP 外渗至肾间质与钙及其他蛋白形成钙蛋白复合物,直接损害肾实质。2.骨髓瘤细胞直接损害肾实质。3.骨髓瘤引起电解质代谢紊乱:
Myeloma Nephropathy is one of the most serious complications of multiple myeloma, with mortality second only to infection. Multiple myeloma in the incidence of nephropathy about 66%, slightly more men than women, more than 50 years of age. Myeloma nephropathy can occur some time before the diagnosis of myeloma, which is often misdiagnosed as primary nephropathy, should be noted. First, the occurrence of myeloma and nephropathy with the following factors: 1. Nephrotoxic light chain: myeloma cells can produce a large number of immunoglobulin, in which light chain molecular weight can be glomerular filtration, into the formation of the renal tubules Tube, blocking the lumen, thereby reducing GFR. In addition, the light chain can directly damage the kidneys. The light chain of the higher electric point can easily cause kidney damage; light chain glycosylation and polymerization can also damage the kidneys; light chain can also promote the formation of tubular Tamm-Horsfall protein (THP) Permeate the renal interstitium and calcium and other proteins to form calprotectin complex, directly damage the renal parenchyma. 2. Myeloma cells directly damage the renal parenchyma. 3. Myeloma electrolyte metabolism caused by disorders: