nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1039Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОбратимость тяжелой почечной недостаточности при миеломной болезниRecovery of severe renal failure in multiple myelomaРехтинаИ. Г.RekhtinaI. G.noemail@neicon.ruГолицинаЕ. П.VarshavskyE.P. Golitsina.noemail@neicon.ruВаршавскийВ. А.GorchakovaS. V.noemail@neicon.ruГорчаковаС. В.BiryukovaL. S.sgorchakova@mail.ruБирюковаЛ. С.noemail@neicon.ruГематологический научный центр РАМНRussian FederationГОУ ВПО Московская медицинская академия им. И.М. Сеченова; г. МоскваRussian Federation200919062025113257262Copyright © Рехтина И.Г., Голицина Е.П., Варшавский В.А., Горчакова С.В., Бирюкова Л.С., 20252025Рехтина И.Г., Голицина Е.П., Варшавский В.А., Горчакова С.В., Бирюкова Л.С.Rekhtina I.G., Varshavsky E.G., Gorchakova S.V., Biryukova L.S., Бирюкова Л.С.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1039

В 10% случаев множественная миелома (ММ) дебютирует с тяжелой уремии, требующей заместительной почечной терапии. Обследовано 14 больных с впервые выявленной ММ, у которых заболевание дебютировало с тяжелой стадии почечной недостаточности (ПН). До начала химиотерапии (ХТ) выполнена пункционная биопсия почки с последующей световой, иммунофлуоресцентной и электронной микроскопией. В результате проведенного лечения функция почек улучшилась у 4 (28%) больных, что позволило отказаться от проведения гемодиализа (ГД). У остальных больных улучшения функции почек после ХТ не произошло, продолжается лечение программным ГД. При исследовании биоптатов почки у больных ММ с тяжелой ПН в 50% случаев выявлен сочетанный характер поражения почек в виде цилиндровой нефропатии и отложения моноклональных легких цепей, а также фибриллярной нефропатии. Миеломная нефропатия (МН), как изолированный вариант поражения, диагностирована в 43% случаев. Морфологическим критерием обратимости ПН является отсутствие распространенного интерстициального фиброза. Выраженный интерстициальный фиброз при МН и тяжелой ПН развивается в течение двух-трех месяцев.

In 10% of cases Multiple myeloma (MM) begins with severe uremia, thus these patients require renal replacement therapy. We studied 14 patients with newly diagnosed MM. In all these patients the disease debuted with severe stage renal failure. Renal biopsy was performed before chemotherapy with the subsequent light, immunofluorescent and electron microscopy. As a result of the treatment renal function has improved in 4 (28%) patients that allowed us to stop haemodialysis. In other patients after chemotherapy the improvement of renal function has not occurred and haemodialysis has been continued. Study of kidneys biopsies of the patients with MM and severe renal failure in 50% of cases has revealed combined character of renal injury: cast nephropathy and monoclonal light chains deposits, and fibrillar nephropathy. Isolated myeloma nephropathy was diagnosed in 43% of cases. The absence of interstitial fibrosis is the morphological criterion of reversibility of renal failure. Significant interstitial fibrosis in МM patients and severe renal failure develop within two-three months.

множественная миеломамиеломная нефропатияпочечная недостаточностьReferencesБирюкова Л.С., Володяева Е.В., Фетисова Е.В. и др. Острая и хроническая почечная недостаточность у больных миеломной болезнью // Терапевт. арх. 1999. Т. 71. С. № 7. С. 58–64.Бирюкова Л.С., Володяева Е.В., Фетисова Е.В. и др. Острая и хроническая почечная недостаточность у больных миеломной болезнью // Терапевт. арх. 1999. Т. 71. С. № 7. С. 58–64.Рехтина И.Г., Рыжко В.В., Чавынчак Р.Б., Бирюкова Л.С. Проблемы лечения и выживаемость больных с множественной миеломой на программном гемодиализе // Терапевтический архив. 2007. № 8. С. 9–13.Рехтина И.Г., Рыжко В.В., Чавынчак Р.Б., Бирюкова Л.С. Проблемы лечения и выживаемость больных с множественной миеломой на программном гемодиализе // Терапевтический архив. 2007. № 8. С. 9–13.Alexanian R., Barlogie B., Dixon D. Renal failure in multiple myeloma. Pathogenesis and prognostic implications // Arch Intern Med. 1990. Vol. 150. P. 1693–1695.Alexanian R., Barlogie B., Dixon D. Renal failure in multiple myeloma. Pathogenesis and prognostic implications // Arch Intern Med. 1990. Vol. 150. P. 1693–1695.Blade J., Fernandez-Llama P., Bosch F. et al. Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution // Arch Intern Med. 1998. Vol. 158 (17). P. 1889–1893.Blade J., Fernandez-Llama P., Bosch F. et al. Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution // Arch Intern Med. 1998. Vol. 158 (17). P. 1889–1893.Goldschidt H., Lannert H., Bommer J., Ho A. Multiple myeloma and renal failure // Nephrol Dial Trasplant. 2000. Vol. 15. P. 301–304.Goldschidt H., Lannert H., Bommer J., Ho A. Multiple myeloma and renal failure // Nephrol Dial Trasplant. 2000. Vol. 15. P. 301–304.Joh K. Pathology of glomerular deposition diseases//Pathology International. 2007. Vol. 57. P. 551–565.Joh K. Pathology of glomerular deposition diseases//Pathology International. 2007. Vol. 57. P. 551–565.Knudsen L.M., Hjorth M., Hippe E. Renal failure in multiple myeloma: reversibility and impact on the prognosis // Eur J Haemat. 2000. Vol. 65. P. 175.Knudsen L.M., Hjorth M., Hippe E. Renal failure in multiple myeloma: reversibility and impact on the prognosis // Eur J Haemat. 2000. Vol. 65. P. 175.Basnayake K, Hutchison C, Kamel D et al. Resolution of cast nephropathy following free light chain removal by haemodialysis in a patient with multiple myeloma: a case report // J Med Case Reports. 2008. Vol. 2. P. 380.Basnayake K, Hutchison C, Kamel D et al. Resolution of cast nephropathy following free light chain removal by haemodialysis in a patient with multiple myeloma: a case report // J Med Case Reports. 2008. Vol. 2. P. 380.Komatsuda A., Wakui H., Ohtani H. et al. Disappearance of nodular mesangial lesions in a patient with light chain nephropathy after long-term chemotherapy // Am J Kidney Dis. 2000. Vol. 35 (3). E9.Komatsuda A., Wakui H., Ohtani H. et al. Disappearance of nodular mesangial lesions in a patient with light chain nephropathy after long-term chemotherapy // Am J Kidney Dis. 2000. Vol. 35 (3). E9.Korbet S.M., Schwartz M.M., Lewis E.J. Immunotactoid Glomerulopathy (Fibrillary glomerulonephritis)// Clin J Am Soc Nephrol. 2006. V. 1. P. 1351–1356.Korbet S.M., Schwartz M.M., Lewis E.J. Immunotactoid Glomerulopathy (Fibrillary glomerulonephritis)// Clin J Am Soc Nephrol. 2006. V. 1. P. 1351–1356.Lee C.-K., Zangari M., Barlogie B. et al. Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant // Bone Marrow Transplant. 2004. Vol. 33 (8). P. 823–828.Lee C.-K., Zangari M., Barlogie B. et al. Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant // Bone Marrow Transplant. 2004. Vol. 33 (8). P. 823–828.Lin J., Markowitz G.S., Valeri A.M. et al. Renal monoclonal immunoglobulin deposition disease: The disease spectrum // J Am Soc Nephrol. 2001. Vol. 12. P. 1482–1492.Lin J., Markowitz G.S., Valeri A.M. et al. Renal monoclonal immunoglobulin deposition disease: The disease spectrum // J Am Soc Nephrol. 2001. Vol. 12. P. 1482–1492.Lome C, Beaufils H., Mougenot B. et al. Non-amyloid monoclonal immunoglobulin light-chain (LC) deposits in renal extracellular matrix // J Am Soc Nephrol. 1997. Vol. 8. 539 A.Lome C, Beaufils H., Mougenot B. et al. Non-amyloid monoclonal immunoglobulin light-chain (LC) deposits in renal extracellular matrix // J Am Soc Nephrol. 1997. Vol. 8. 539 A.Magee C., Vella J.P., Tormey W.P., Walshe J.J. Multiple myeloma and renal failure: one centers experience // Ren Fail. 1998. Vol. 20 (4). P. 597–606.Magee C., Vella J.P., Tormey W.P., Walshe J.J. Multiple myeloma and renal failure: one centers experience // Ren Fail. 1998. Vol. 20 (4). P. 597–606.Markowitz G.S., Fine P.L., Stack I. et al. Toxic acute tubulas necrosis following treatment with zoledronate // Kidney Int. 2003. Vol. 64 (1). P. 281–289.Markowitz G.S., Fine P.L., Stack I. et al. Toxic acute tubulas necrosis following treatment with zoledronate // Kidney Int. 2003. Vol. 64 (1). P. 281–289.Martin R.G., Valera A., Frutos M.A., Ramos B. et al. Survival of myeloma patients treated with dialysis // Nefrologia. 2003. Vol. 23 (2). P. 131–136.Martin R.G., Valera A., Frutos M.A., Ramos B. et al. Survival of myeloma patients treated with dialysis // Nefrologia. 2003. Vol. 23 (2). P. 131–136.Nicastri A.L., Prado M.J., Dominguez W.V., Prado E.B. Nephrotoxicity of Bence-Jones proteins: interference in renal epithelial cell acidification // Braz J Med Biol Res. 2002. Vol. 3. P. 357–360.Nicastri A.L., Prado M.J., Dominguez W.V., Prado E.B. Nephrotoxicity of Bence-Jones proteins: interference in renal epithelial cell acidification // Braz J Med Biol Res. 2002. Vol. 3. P. 357–360.Pandit S.R., Vesole D.H. Management of renal dysfunction in multiple myeloma // Curr Treat Optipns Oncol. 2003. Vol. 4. P. 239–246.Pandit S.R., Vesole D.H. Management of renal dysfunction in multiple myeloma // Curr Treat Optipns Oncol. 2003. Vol. 4. P. 239–246.Perazella M.A., Markowitz G.S. Bisphosphonate nephrotoxicity // Kidney Int. 2008. Vol. 74. P. 1385–1393.Perazella M.A., Markowitz G.S. Bisphosphonate nephrotoxicity // Kidney Int. 2008. Vol. 74. P. 1385–1393.Pichette V., Querin S., Desmeules M. et al. Renal function recovery in end-stage renal disease // Am J Kidney Dis. 1993. Vol. 22. P. 398–402.Pichette V., Querin S., Desmeules M. et al. Renal function recovery in end-stage renal disease // Am J Kidney Dis. 1993. Vol. 22. P. 398–402.Pozzi C., D Amigo M., Fogazzi B. et al. Light chain deposition disease with renal involvement: Clinical characteristics and prognosis factors. Am J Kidney Dis. 2003; 42: 1154–1163.Pozzi C., D Amigo M., Fogazzi B. et al. Light chain deposition disease with renal involvement: Clinical characteristics and prognosis factors. Am J Kidney Dis. 2003; 42: 1154–1163.Ronco P.M., Alyanakian M.A., Mougenot B., Aucouturier P. Light chain deposition disease: a model of glomerulosclerosis defined at the molecular level // Am Soc Nephrol. 2001. Vol. 12. P. 1558–1565.Ronco P.M., Alyanakian M.A., Mougenot B., Aucouturier P. Light chain deposition disease: a model of glomerulosclerosis defined at the molecular level // Am Soc Nephrol. 2001. Vol. 12. P. 1558–1565.Rota S., Mougenot B., Baudouin B. et al. Multiple myeloma and severe renal failure: a clinicopathologic study of outcome and prognosis in 34 patients // Medicine. 1987. Vol. 66. P. 126–137.Rota S., Mougenot B., Baudouin B. et al. Multiple myeloma and severe renal failure: a clinicopathologic study of outcome and prognosis in 34 patients // Medicine. 1987. Vol. 66. P. 126–137.Sakhuja V., Jha V., Varma S. et al. Renal involvement in multiple myeloma: a 10-year study // Ren Fal. 2000. Vol. 22 (4). P. 465–477.Sakhuja V., Jha V., Varma S. et al. Renal involvement in multiple myeloma: a 10-year study // Ren Fal. 2000. Vol. 22 (4). P. 465–477.San Miguel J.F., Lahuerta J.J., Garcia-Sanz R. et al. Are Myeloma patients with renal failure candidates for autologous stem cell transplantation? // Hematol J. 2000. Vol. 1 (1). P. 28–36.San Miguel J.F., Lahuerta J.J., Garcia-Sanz R. et al. Are Myeloma patients with renal failure candidates for autologous stem cell transplantation? // Hematol J. 2000. Vol. 1 (1). P. 28–36.Santostefano M., Zanchelli F., Zaccaria A. et al. The ultrastructural basis of renal pathology in monoclonal gammapathies // J Nephrol. 2005. Vol. 18. P. 659–675.Santostefano M., Zanchelli F., Zaccaria A. et al. The ultrastructural basis of renal pathology in monoclonal gammapathies // J Nephrol. 2005. Vol. 18. P. 659–675.Spasov E., Goranova V. Prognostic assessment of the Durie and Salmon staging system in patients with multiple myeloma // Folia Med. 1998. Vol. 40. P. 121–123.Spasov E., Goranova V. Prognostic assessment of the Durie and Salmon staging system in patients with multiple myeloma // Folia Med. 1998. Vol. 40. P. 121–123.Tauro S., Clark F.J., Duncan N. et al. Recovery of function after autologous stem cell transplantation in myeloma patients with end-stage renal failure // Bone Marrow Transplant. 2002. Vol. 30 (7). P. 471–473.Tauro S., Clark F.J., Duncan N. et al. Recovery of function after autologous stem cell transplantation in myeloma patients with end-stage renal failure // Bone Marrow Transplant. 2002. Vol. 30 (7). P. 471–473.Torra R., Blade J., Cases A. et al. Patients with multiple myeloma requiring long-term dialysis: presenting features, response to therapy, and outcome in a series of 20 cases // Br J Haematol. 1995. Vol. 91. P. 854–859.Torra R., Blade J., Cases A. et al. Patients with multiple myeloma requiring long-term dialysis: presenting features, response to therapy, and outcome in a series of 20 cases // Br J Haematol. 1995. Vol. 91. P. 854–859.Viertel A., Weidmann E., Ditting T., Geiger H. Management of renal complications in patients with advanced multiple myeloma // Leuk Lymphoma. 2000. Vol. 38 (5–6). P. 513–519.Viertel A., Weidmann E., Ditting T., Geiger H. Management of renal complications in patients with advanced multiple myeloma // Leuk Lymphoma. 2000. Vol. 38 (5–6). P. 513–519.

The authors declare that there are no conflicts of interest present.