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多发性骨髓瘤起病隐袭,临床表现多样,误诊率高达54％～100％,以肾脏损害为首发表现者多见,更易误诊。本文收集近10年收治的31例多发性骨髓瘤致肾脏损害的资料分析如下: 1 临床资料 1.1 一般资料 男24例,女7例,年龄27岁～73岁,40岁以上23例。所有病例均经骨髓穿刺或骨髓活检找到骨髓瘤细胞并伴有肾脏损害,其中以肾脏损害为首发表现者13例(急性肾衰4例,慢性肾衰7例,肾病综合征2例)。 1.2 临床表现 多尿、夜尿25例(占80.1％),蛋白尿21例(占67.7％),贫血27例(占87.1％),肾功能不全11例(占35.5％)。 1.3 实验室检查 尿本周氏蛋白阳性18例,26例血清蛋白电泳见M带20例。按免疫球蛋白分型,IgG型11例,IgA型5例,轻链型3例,IgD型1例。19例B超检查肾脏增大者12例。23例行X线检查,21例发现有溶骨病变或弥漫性骨质疏松。
Multiple myeloma insidious onset, clinical manifestations and diverse, misdiagnosis rate as high as 54% to 100%, kidney damage as the first performance more common, more easily misdiagnosed. This collection of nearly 10 years admitted to 31 cases of multiple myeloma caused by renal damage as follows: 1 Clinical data 1.1 General Information 24 males and 7 females, aged 27 years to 73 years old, over the age of 40 23 cases. All cases were found by bone marrow biopsy or bone marrow biopsy myeloma cells associated with renal damage, of which 13 cases of kidney damage as a first manifestation (acute renal failure in 4 cases, 7 cases of chronic renal failure, nephrotic syndrome in 2 cases). 1.2 Clinical manifestations of polyuria, nocturnal 25 cases (80.1%), proteinuria in 21 cases (67.7%), anemia in 27 cases (87.1%), renal insufficiency in 11 cases (35.5%). 1.3 Laboratory tests Urine Week’s protein positive in 18 cases, 26 cases of serum protein electrophoresis in M with 20 cases. According to immunoglobulin typing, 11 cases of IgG, 5 cases of IgA, 3 cases of light chain and 1 case of IgD. 19 cases of B-ultrasound in 12 cases of renal enlargement. 23 cases of X-ray examination, found in 21 cases of osteolytic or diffuse osteoporosis.