Kidney diseases, provoked by other pathologies, require the therapy of the underlying cause of the disease, as a result of which nephrologic pathology is cured or remission itself. But if the cause of the disease is incurable, the patient needs a special approach. This can be seen on the example of myeloma nephropathy.
Myeloma nephropathy
Myeloma nephropathy is a lesion of the glomerulus and kidney tubules in the background of myeloma. Myeloma is a malignant oncology in which the human bone marrow produces a large number of plasma cells.
Pathological protein released into the bloodstream by myeloma cells is deposited in the kidney tissues, leading to a phenomenon such as nephropathy - tissue scarring. To date, this disease is incurable. In addition, it is difficult to diagnose.
Code of the disease according to ICD-10 - C90.
Pathogenesis of
Plasma cells circulating in the bloodstream of myeloma produce the protein Bence-Jones Protein( Bence-Jones).The size of the protein molecule allows it to pass through the holes in the kidney membranes, even with their integrity, that is, with an absolutely healthy and undamaged tissue, the glomerulus. But if the protein is oxidized inside the kidney, the process of its coagulation takes place, and the resulting substance blocks the work of the glomerulus.
In addition, impaired filtration due to blocked renal channels leads to nephroptosis, which also provokes kidney damage.
Myeloma nephropathy proceeds at different rates, but the prognosis is always unfavorable. With the help of early diagnosis, which is statistically very rare, doctors can achieve remission of a patient that lasts up to 5 years( in exceptional cases, up to 10 years).
Symptoms
A distinctive feature of myeloma nephropathy is the non-specificity of the symptoms. Comparing the pathology with glomerulonephritis, which also fixes damage to the kidney tissues, it can be seen that in the first case the patient encounters a classic picture of chronic nephrogenic insufficiency: the formation of pastosis and swelling and an increase in the level of blood pressure.
In myeloma nephropathy, functional renal failure progresses with great speed, but without any symptoms indicative of this process. This negatively affects the diagnostic process and deprives the patient of the opportunity to begin treatment in a timely manner.
The only specific feature that is always present in the clinical picture of the disease against the background of myeloma is proteinuria, in other words, the presence of protein in urine. In this case, it is more important to speak and macroproteinuria, since the amount of protein in the urine can reach 50-60 grams per liter.
Sometimes proteinuria can be seen even without conducting a urine test - a cap of foam formed during urination. But this characteristic can not be characterized as specific, in addition, this fact is easily overlooked.
Given the fact that myeloma affects not only the kidneys, but also the human bone system, the list of symptoms includes bone pain.
Diagnosis
Diagnosis of nephropathy in myeloma usually begins with an analysis of urine and the detection of proteinuria. It is important to differentiate pathology from glomerulonephritis. If the patient has not previously had staphylococcal and streptococcal infections, as well as acute form of glomerulonephritis, there is reason to suspect myeloma nephropathy and continue the diagnosis.
The exact diagnosis is made after three studies:
- urine electrophoresis, which determines the composition of urine and detects in it not albumin, but the Bens-Jones protein;
- detection of paraproteins in blood and urine;
- conducting a sternal puncture to determine the number of plasma cells.
Nephrobiopsy is part of the diagnostic plan for suspected myeloma nephropathy extremely rarely, since tissue sampling from the organ for microscopic examination is a rather difficult and technically dangerous process. Sternary puncture, together with the analysis of urine and blood can make the diagnosis as accurate as possible.
Treatment of
Treatment of myeloma and concomitant nephropathy does not exist. Before doctors, the task is to bring the disease into remission, thereby prolonging life for several years. For this purpose, glucocorticosteroids and cytostatics are used, which suppress the activity of immunity.
But the complication is the fact that these drugs from these groups are contraindicated in case of nephrogenic insufficiency. Therefore, a patient with CRF is recommended symptomatic therapy designed to support his well-being, and plasmapheresis, which will remove the Bens-Jones protein from the bloodstream.
Also in the treatment is the appointment of diuretics and the use of large amounts of liquid.
The video causes, symptoms, diagnosis and treatment of myeloma nephropathy: