and the Kidney Welcome to the UNC 多发性骨髓瘤和肾欢迎到ppt课件.ppt

美国自发性脑出血处理指南课件慢性鼻炎吃什么药好慢性鼻窦炎吃什中医中药治疗高血脂饮食保健资料子宫肌瘤合并胆囊炎围手术期护理中医药对冠心病稳定性心绞痛长期治疗价值 慢性单纯性苔藓痤疮白癜风教材课程 美国自发性脑出血处理指南课件慢性鼻炎吃什么药好慢性鼻窦炎吃什中医中药治疗高血脂饮食保健资料子宫肌瘤合并胆囊炎围手术期护理中医药对冠心病稳定性心绞痛长期治疗价值 慢性单纯性苔藓痤疮白癜风教材课程 Myeloma and the Kidney Ryan Sanford 2.22.2010 How Often is the Kidney Involved Symptomatic MM: CRAB hyperCalcemia Renal dysfunction Anemia Bone lesions 1/5 to 2/5 patients with MM have renal involvement What Does it Signify? At presentation SCr 1.5 ? 80% alive at 1 year SCr 2.3 ? 50% alive at 1 year Renal Improvement to MM Treatment also favorable The Immunoglobulin Light Chains come in lambda and kappa A Few General Points First The Proteins of MM Light chains (LC) almost always the problem Various potential proteins to be produced Intact immunoglobulins +/- Light Chains and Heavy Chains The SPEP: Not a good test to identify LCs Increased sensitivity if coupled with serum immunofixation Can only quantify LCs with direct assessment The UPEP Prior to serum free light chain assessment, the UPEP was the test of choice to find LCs The Light Chain (LC) aka Bence Jones proteins Monoclonal A ratio of κ:λ Freely filtered, absorbed in PCT The LC biochemical properties determines the type, if any, of renal disease The Serum Free Light Chain Assessment Polyclonal ABs directed at hidden LC epitopes (when a full Ig) used for sensitive quantification of κ and λ light chains Coupled with SPEP more Sn/Sp than SPEP/UPEP Could be replacing UPEP as test of choice What Types of Involvement Light chain cast nephropathy – Myeloma Kidney [40% of cases] Light chain deposition disease [10%] Primary AL Amyloidosis [10%] Also: Hypercalcemia, interstitial nephritis, acquired Fanconi’s syndrome, GN Proteinuria in MM Albuminuria [a grossly positive U/a for protein] If positive: Nonspecfic glomerular leak, nephrosis LCDD or Amyloidosis If negative: other proteins or no protein in urine; cast nephropathy Addition of Sulfosalicylic Acid to Supernatant If bland sediment and minimal protein on