目的探讨多发性骨髓瘤(multiplemyemoma,MM)肾损害的临床特点。方法对36例MM肾损害患者的临床资料进行回顾性分析。结果≥60岁年龄组与<60岁年龄组、IgG型与IgA型肾功能不全发生率比较均有统计学意义(P<0.05);22例(61%)有骨骼疼痛,10例(28%)有出血,合并感染22例(61%),4例(11%)有高黏滞血症,1例有痛风,血压升高1例,首发症状为水肿、恶心、乏力、夜尿增多、纳差等肾功能不全症状7例(19%);初次诊断为肾脏疾病9例(25%);全组病例有不同程度的贫血,均有肾功能损害(血清肌酐190~1276μmol/L),血钙升高15例(42%),血尿酸升高25例(69%),Χ线检查示有溶骨性破坏和/或广泛骨质疏松30例(83.3%),合并病理性骨折11例(30.6%),B超双肾弥漫性损害18例(50%);5例放弃治疗,31例行化疗,化疗患者中位生存时间19.7个月,2例死于肾功能衰竭。结论多发性骨髓瘤临床表现复杂,临床上易误诊为肾脏疾病。老年MM易发生肾功能不全,IgA型较IgG型易发生肾功能不全;有效的化疗,输液、利尿,积极治疗高钙血症、感染及高尿酸血症,血液透析等,可延缓肾损害的进展,改善预后。 Objective To investigate the clinical features of multiple myeloma (MM) with renal damage. Methods The clinical data of 36 patients with MM nephropathy were retrospectively analyzed. Results There were significant differences in the incidence of IgG and IgA renal insufficiency between the age of 60 and the age of 60 (P <0.05). Twenty-two patients (61%) had skeletal pain and 10 patients (28% ) Had hemorrhage, 22 cases (61%) had combined infection, 4 cases (11%) had hyperviscosity, 1 had gout and 1 case had elevated blood pressure. The first symptom was edema, nausea and fatigue, increased nocturia, (19%) were diagnosed as renal dysfunction, 9 cases (25%) were diagnosed as renal disease for the first time, and all groups had anemia of different degrees with renal dysfunction (serum creatinine 190 ~ 1276μmol / L) Serum calcium increased in 15 cases (42%), uric acid increased in 25 cases (69%), X-ray examination showed osteolytic destruction and / or extensive osteoporosis in 30 cases (83.3%), with pathological fracture 11 (30.6%), 18 cases (50%) of B supermanial diffuse damage; 5 patients give up treatment, 31 patients received chemotherapy, the median survival time of chemotherapy patients was 19.7 months, 2 patients died of renal failure. Conclusion The clinical manifestations of multiple myeloma are complicated and clinically misdiagnosed as kidney disease. Elderly MM prone to renal insufficiency, IgA type than IgG prone to renal insufficiency; effective chemotherapy, infusion, diuretic, active treatment of hypercalcemia, infection and hyperuricemia, hemodialysis, etc., can delay renal damage Progress, improve the prognosis.