多发性骨髓瘤并发急性肾功能衰竭1例并文献复习

One Case of Acute Kidney Failure Caused by Multiple Myeloma and Literature Review

摘要: 目的：本文通过1例以急性肾功能衰竭为表现的多发性骨髓瘤病例进行分析，探讨该病的流行病学、病因及机制、临床表现、诊断及治疗，在临床工作中避免漏诊、误诊，提高对该病程度，早诊早治，改善患者预后。方法：选取1例多发性骨髓瘤并发急性肾损伤的病例，结合分析相关国内外文献，对该病诊断治疗等进行探讨。结果：患者因“发现蛋白尿半年，伴恶心10天”入院，骨髓活检示多发性骨髓瘤，肌酐1053.30 umol/L。诊断：多发性骨髓瘤(ISS-II期，DS-I期)、急性肾衰竭尿毒症期、高血压病3级(极高危)、干燥综合征、高尿酸血症、肺部感染，予以规律血液透析及1周期PAD (硼替佐米1.7 mg•dl，多柔比星脂质体20 mg•dl，地塞米松20.25 mg•dl−2)方案化疗，病情好转出院。结论：多发性骨髓瘤患病率近年来逐渐升高，少数患者以少尿、蛋白尿等急性肾功能衰竭为表现，部分患者因此丧失独立肾功能，早期发现、尽早制定合理治疗方案能较大程度上逆转肾功能，改善患者预后，延长患者中位生存期。

Abstract: Objective: By analyzing a case of multiple myeloma with acute renal failure as its manifestation, this paper discusses the epidemiology, etiology and mechanism, clinical manifestations, diagnosis and treatment of the disease, so as to avoid missed diagnosis and misdiagnosis in clinical work, improve the degree of the disease, early diagnosis and early treatment, and improve the prognosis of pa-tients. Methods: A case of multiple myeloma complicated by acute kidney injury was selected for the diagnosis and treatment of relevant domestic and foreign literature. Results: The patient was admitted because “proteinuria was found for half a year, accompanied by nausea for 10 days”. Bone marrow biopsy showed multiple myeloma, with creatinine of 1053.30 umol/L. Diagnosis: Multiple myeloma (ISS-II, DS-I), acute renal failure, uremia, hypertension grade 3 (extremely high risk), Sjogren’s syndrome, hyperuricemia, pulmonary infection, regular hemodialysis and one cycle of PAD (bortezomib 1.7 mg•dl, doxorubicin liposome 20 mg•dl, dexamethasone 20.25 mg•dl−2) chem-otherapy were given, and the patient’s condition improved and he was discharged. Conclusion: The prevalence rate of multiple myeloma has gradually increased in recent years. A few patients show acute renal failure such as oliguria and albuminuria, and some patients lose independent renal function. Early detection and early formulation of a reasonable treatment plan can largely reverse renal function, improve the prognosis of patients, and extend the median survival period of pa-tients.