SUCCESSFUL TREATMENT OF MYELOMA KIDNEY BY DIURESIS AND PLASMAPHORESIS
SUCCESSFUL TREATMENT OF MYELOMA KIDNEY BY DIURESIS AND PLASMAPHORESIS
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DOI：
10.1136/bmj.1.6008.503
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发表时间：
1976-01-01
影响因子：
--
通讯作者：
COHEN, SL
中科院分区：
文献类型：
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作者：
FEEST, TG;BURGE, PS;COHEN, SL
当骨髓瘤病发生急性肾功能衰竭时，预后很差：在一个系列中，14例患者中有13例在两个月内死亡。骨髓瘤中本-琼斯蛋白尿的发生与肾功能衰竭有很强的相关性。1 2这些蛋白质在肾衰竭发病机制中的确切作用尚不确定，但轻链对肾小管的直接毒性3和管型引起的肾小管阻塞4均已被假定。通过尝试从肾脏中去除Bence Jones蛋白来治疗骨髓瘤肾，并通过从血清中去除它们来防止再累积似乎是合理的。如果尿液被浓缩，pH值低于6，并且存在溶质和白蛋白，则本琼斯蛋白最容易沉淀。因此，碱性利尿剂应有助于防止管型形成，并可能清除现有的管型。这种治疗已经显示出保护患有Bence Jones蛋白尿的小鼠免受肾损伤，减少管型形成，并且已经防止患有mye-lomatosis的患者的肾衰竭的进展。4
DiscussionWhen acute renal failure occurs in myelomatosis the prognosis is poor: in one series 13 of 14 patients died within two months'. There is a strong correlation between the occurence of Bence Jones pro-teinuria and renal failure in myeloma. 1 2 The precise role of these proteins in the pathogenesis of renal failure is uncertain, but direct toxicity of light chains to the renal tubule, 3 and tubular obstruction by casts4 have both been postulated. It seems reasonable to treat myeloma kidney by attempting to remove Bence Jones proteins from the kidney, and to prevent reac-cumulation by removing them from the serum. Bence Jones protein precipitates most readily if the urine is concentrated, the pH is below 6, and solutes and albumin are present. 5 An alkaline diuresis should thus help to prevent cast formation, and possibly remove existing casts. Such treatment has been shown to protect mice with Bence Jones proteinuria from renal damage, reducing cast formation, and has prevented progression of renal failure in a patient with mye-lomatosis. 4