Etiology of multiple myeloma nephropathy

Etiology of multiple myeloma nephropathy

1 a large number of light chain proteins cause renal tubular damage:

Myeloma cells to produce abnormal monoclonal immunoglobulin, wherein the immunoglobulin light chain due to large molecular weight, from glomerular filtration, poured into the renal tubules, far more than the maximum tubular reabsorption rate of light chain protein too much from the urine, called overflow proteinuria. The most important feature of MMN is the presence of a large number of light chain immunoglobulin in the renal tubule, forming a special type of tube, leading to renal tubular obstruction, but also can cause renal tubular damage.

2 high calcium nephropathy:

In addition to the secretion of monoclonal immunoglobulin, the tumor cells also secrete a large number of osteoclast activating factors, which stimulate osteoclasts, produce localized osteolysis, and increase calcium into the blood. In addition, the lesion location of myeloma lesions was inhibited by osteoblast activation. These factors can cause hypercalcemia, hypercalciuria, renal tissue and renal function damage. High blood calcium and high urinary calcium promote calcium salt in the renal tubule and interstitial, cause renal calcium deposition disease. Extensive calcium deposition, resulting in decreased renal function. High concentration of calcium salt in the renal tubule and BJP polymerization into the tube or form a stone, further damage renal tubular function. Therefore, hypercalcemia and light chain protein is considered to be the major risk factors of MMN.

3 uric acid nephropathy:

MM patients due to tumor cell destruction, or chemotherapy, nucleic acid catabolism increased, resulting in excessive blood uric acid secondary hyperuricemia. Long term hyperuricemia, in the low oxygen, low pH state of the renal medulla is easy to make uric acid deposition, so that tubulointerstitial damage. In addition, urate crystals not only damage renal tubular epithelial cells, but also block the renal lumen, the formation of renal obstruction, obstructive nephropathy.

4 tumor cell infiltration:

Bone marrow is the main organ to produce plasma cells, so the primary lesion of MM is mainly in bone marrow. In addition to the bone marrow, lymph node, spleen, digestive tract, upper respiratory mucosa of the lymphatic tissue can also produce plasma cells, the primary lesions. In addition to the original lesion location, tumor cells can also be widely infiltrated other organs, kidney, lung, gastrointestinal tract, heart, thyroid, testis, ovary, uterus, adrenal gland, subcutaneous tissue can also be affected. The invasion of renal parenchyma by tumor cells can destroy the renal tissue. It is generally believed that tumor cells are more likely to be infiltrated into renal tissue. Once the renal volume was significantly increased.

5 renal amyloidosis:

MM monoclonal immunoglobulin light chain and polysaccharide compound deposition in the tissues and organs, caused by amyloidosis caused by corresponding clinical manifestations, such as tongue hypertrophy, hepatosplenomegaly, cardiac enlargement, peripheral neuropathy, renal function impairment. It can cause renal amyloidosis, amyloid fibrils are mainly deposited in glomerular basement membrane, mesangial, renal tubular basement membrane and stroma, and finally lead to renal failure.

6 hyperviscosity syndrome:

Myeloma cells secrete a large number of monoclonal immunoglobulin, so that increased blood viscosity, resulting in renal hemodynamics and microcirculation disorders.

7 cold globulin:

Abnormal immunoglobulin has the characteristics of cold deposition, which is easy to accumulate in glomerular capillaries, leading to renal damage.

8 urinary tract infection:

MM patients with low body resistance, easy to have urinary tract infection. The cause of systemic resistance, one is immunodeficiency, myeloma cells secrete some substances that inhibit macrophage function, normal immunoglobulin synthesis which mediated inhibition; two is abnormal light chain protein secretion in myeloma cell damage of blood circulating granulocyte phagocytosis of bacteria and conditioning. In addition, the local factors leading to urinary tract infection, urinary catheter and urate crystal block the renal tubule, urinary tract obstruction caused by urinary stones, urinary tract mucosal local resistance decreased.


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