多发性骨髓瘤铸型肾病的支持治疗一项初步研究

Q3 Medicine
G. Cancarini, Vincenzo Terlizzi, Anna Garatti, Letizia Zeni, Mattia Tonoli, Elena Pezzini, F. Boni, S. Possenti, B. F. Viola, M. Gaggiotti
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引用次数: 4

摘要

引言:铸造肾病是骨髓瘤患者急性肾损伤(AKI)的常见原因。目的:本研究的目的是确定标准化支持治疗铸造肾病的结果。患者和方法:回顾性分析一所大学医院五年来铸造肾病的预后。分析的数据;血清肌酐、估计肾小球滤过率(eGFR;mL/min/1.73mBSA)和透析需要。以预防/移除管状铸型为目的的标准化治疗;液体给药和甘露醇增加尿流量,碳酸氢钠碱化尿液,低剂量类固醇减少管周炎症。统计分析:根据数据分布进行Student t检验或Mann-Whitney检验。双尾P值<0.05被认为具有统计学意义。根据Kaplan和Meier绘制生存曲线。结果:对27例病例进行了回顾性分析。入院时,平均血清肌酐为7.1±4.9 mg/dL,平均eGFR为6±4 mL/min/1.73 m2 BSA;30%的患者有少无尿。23名患者被推定为铸造肾病,4名患者被证实为肾活检。10名(37%)患者需要血液透析,其中两名患者出院后继续透析。出院时,血清肌酐为3.7±2.5 mg/dL,eGFR为20±13 mL/min/1.73 m2 BSA(P=0.002),中位3.4个月后,其值分别为2.9±2.1 mg/dL和35±32 mL/min/1.76 m2 BSA。24个月后患者存活率为60%。结论:液体、甘露醇、碳酸氢钠和小剂量类固醇治疗可改善铸态肾病的疗效。尽管这项研究有很多局限性,但它的发现可能是铸态肾病前瞻性对照试验的基础,并且可能在那些没有昂贵体外治疗的国家有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Supportive treatment for cast nephropathy in patients with multiple myeloma; a pilot study
Introduction: Cast nephropathy is a prevalent cause of acute kidney injury (AKI) in patients with myeloma. Objectives: The aim of this study is to define the outcome of a standardized supportive therapy for cast nephropathy. Patients and Methods: Retrospective analysis of the outcome of cast nephropathy in a University hospital for a period of five years. Data analysed; serum creatinine, estimated glomerular filtration rate (eGFR; mL/min/1.73 m2 BSA) and need for dialysis. Standardized therapy with the aim of preventing/removing tubular casts; fluid administration and mannitol to increase urine flow, sodium bicarbonate to alkalize the urine and low dose steroid to reduce peritubular inflammation. Statistical analysis: Student’s t-test or the Mann-Whitney test according to data distribution. A two-tailed P value <0.05 was considered statistically significant. Survival curve was drawn according to Kaplan and Meier. Results: Twenty-seven cases were reviewed. Upon admission, mean serum creatinine was 7.1±4.9 mg/dL and mean eGFR 6±4 mL/min/1.73 m2 BSA; 30% of patients had oligo-anuria. Diagnosis of cast nephropathy was presumptive in 23 patients, and renal biopsy proven in four. Hemodialysis was required by 10 (37%) patients, two of whom continued dialysis after discharge. At discharge, serum creatinine was 3.7±2.5 mg/dL and eGFR 20±13 mL/min/1.73 m2 BSA (P=0.002), and after a median of 3.4 months, the values were 2.9±2.1 mg/dL and 35±32 mL/min/1.73 m2 BSA, respectively. Patient survival was 60% after 24 months. Conclusion: Administration of fluid, mannitol, sodium bicarbonate and low-dose steroid may improve the outcome of cast nephropathy. Despite the fact that the study has many limitations, its findings could be the base for prospective controlled trials on cast nephropathy and could be useful in those countries where the expensive extracorporeal treatments are not available.
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来源期刊
Journal of Nephropharmacology
Journal of Nephropharmacology Medicine-Pharmacology (medical)
CiteScore
1.70
自引率
0.00%
发文量
18
审稿时长
4 weeks
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