文章：

尿白蛋白排泄率和血清游离轻链降低是多发性骨髓瘤伴中重度肾功能不全患者肾脏反应的重要决定因素

Percentage of urinary albumin excretion and serum-free light-chain reduction are important determinants of renal response in myeloma patients with moderate to severe renal impairment

原文发布日期：2014-08-01

DOI: 10.1038/bcj.2014.56

类型: Original Article

开放获取: 是

英文摘要：

Reversal of renal dysfunction significantly affects the prognosis of multiple myeloma (MM) with renal impairment (RI). There is no reliable test for predicting reversibility of RI in MM patients. We postulated that MM with high albuminuria may reflect glomerular disease that is difficult to reverse. Here, we examined the impact of urinary albumin excretion. We retrospectively analyzed 279 patients admitted to our hospital from April 2000 to December 2013. Clinical variables and laboratory data that may affect myeloma treatment response were extracted. The results were examined for relationship to renal response by univariate and multivariate analysis. RI (estimated glomerular filtration rate ≦50 ml/min per 1.73 m2) was observed in 116 patients (46%) and renal responses of renal complete response, renal partial response, renal minor response and no response were obtained in 46 (40%), 15 (13%), 13 (11%) and 42 (36%) patients, respectively. Although renal recovery was significantly associated with Durie–Salmon 1 or 2 (P=0.02), myeloma response better than very good partial response (P=0.03), involved free light-chain (iFLC) reduction from baseline 80% at day 12 (P=0.005), ≧95% at day 21 (P<0.001) and urinary albumin ≦25% on admission (P<0.001) on univariate analysis, only reduction of iFLC 95% at day 21 (P=0.015) and urinary albumin ≦25% (P=0.007) remained significant for any renal response. Our observation indicates that increased urinary albumin excretion >25% and reduction of iFLC ≦95% on day 21 were associated with favorable renal recovery in MM patients with RI, and were considered as negative predictors for renal response.

摘要翻译： 

肾功能逆转显著影响伴有肾功能损害的多发性骨髓瘤患者的预后。目前尚无可靠检测方法可预测多发性骨髓瘤患者肾功能损害的可逆性。我们提出假设：伴有高度蛋白尿的多发性骨髓瘤可能反映难以逆转的肾小球病变。本研究通过检测尿白蛋白排泄量探讨其影响。我们回顾性分析了2000年4月至2013年12月期间收治的279例患者，提取可能影响骨髓瘤治疗反应的临床变量和实验室数据，通过单因素和多因素分析检验结果与肾脏反应的关系。在116例（46%）观察到肾功能损害（估算肾小球滤过率≤50毫升/分钟/1.73平方米），其中分别有46例（40%）、15例（13%）、13例（11%）和42例（36%）达到肾脏完全缓解、肾脏部分缓解、肾脏轻微缓解及无缓解。单因素分析显示，虽然肾脏功能恢复与Durie–Salmon分期1或2期、优于非常好的部分缓解的骨髓瘤反应、第12天受累游离轻链较基线降低80%、第21天降低≥95%以及入院时尿白蛋白≤25%显著相关，但多因素分析仅第21天受累游离轻链降低≥95%和尿白蛋白≤25%对所有类型的肾脏反应保持显著相关性。我们的观察表明，尿白蛋白排泄量增加>25%及第21天受累游离轻链降低≤95%与多发性骨髓瘤合并肾功能损害患者的良好肾脏恢复相关，被视为肾脏反应的负面预测因子。

原文链接：

Percentage of urinary albumin excretion and serum-free light-chain reduction are important determinants of renal response in myeloma patients with moderate to severe renal impairment