Bubrežna insuficijencija u osoba s multiplim mijelomom

master's thesis

• Title (english): Renal failure in multiple myeloma patients
• Author: Fran Petričević
• Mentor: Ana Planinc-Peraica (mentor)
• Committee member: Slobodanka Ostojić-Kolonić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ana Planinc-Peraica (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Multipli mijelom zloćudna je hematološka bolest karakterizirana proliferacijom klonalnih plazma stanica u koštanoj srži. Bubrežna insuficijencija česta je komplikacija u osoba s multiplim mijelomom. Patogeneza bubrežne insuficijencije povezana je s povećanom serumskom koncentracijom monoklonalnih slobodnih lakih lanaca (FLC, free light chains) koje proizvode maligne plazma stanice. Cilindarska nefropatija najčešći je uzrok teške akutne bubrežne insuficijencije u bolesnika s multiplim mijelomom. 20-40% oboljelih ima bubrežnu insuficijenciju pri dijagnozi i do 50% bolesnika s multiplim mijelomom razvije bubrežnu insuficijenciju tijekom trajanja bolesti. Prema kriterijima CRAB (hiperkalcijemija, bubrežna insuficijencija, anemija i koštane lezije) bubrežno oštećenje definirano je serumskom koncentracijom kreatinina >177 μmol/l (>2 mg/dl). Velik broj bolesnika ne zadovoljava taj kriterij i korištenje procijenjene glomerularne filtracije omogućuje precizniju procjenu bubrežne funkcije. Većina bolesnika pri dijagnozi ima blagu do umjereno tešku bubrežnu insuficijenciju i rana dijagnoza i žurni početak liječenja ostaju ključni postupci za oporavak bubrežne funkcije i prevenciju komplikacija. Serumski test FLC-a nezamjenjiv je u detekciji FLC-a (posebice u bolesnika s oligosekreternom i nesekretornom bolesti) i praćenju bolesnika s već utvrđenim multiplim mijelomom s ciljem procjene odgovora na terapiju i dijagnosticiranja relapsa bolesti. Liječenje akutne bubrežne insuficijencije sastoji se od potporne i antimijelomske terapije. Uvođenje novih lijekova (bortezomib, talidomid, lenalidomid) pridonijelo je značajnom poboljšanju ishoda u bolesnika s multiplim mijelomom i bubrežnom insuficijencijom. Terapija bazirana na bortezomibu u kombinaciji s visokom dozom deksametazona smatra se prvom linijom liječenja u tih bolesnika.

Abstract (english)

Multiple myeloma is a malignant hematologic disease characterised by proliferation of clonal plasma cells in the bone marrow. Renal failure is a common complication in individuals with multiple myeloma. The pathogenesis of renal failure is related to the high serum concetration of monoclonal free light chains (FLC) produced by malignant plasma cells. Cast nephropathy is the most common cause of severe acute renal failure in patients with multiple myeloma. Among newly diagnosed patients, 20-40% have renal failure and approximately 50% of patients with multiple myeloma experience renal failure during the course of their disease. According to CRAB criteria (elevated calcium level, renal failure, anaemia and bone lesions) renal end-organ damage is defined by serum creatinine level of >177 μmol/l (>2 mg/dl). A lot of patients with renal failure do not meet this criterion and using estimated glomerular filtration gives more accurate estimation of renal function. Majority of patients have mild to moderate renal failure at the time of diagnosis and rapid diagnosis and intervention remain key to recover renal function and prevent complications. Serum FLC assay is invaluable in detection of FLC (particulary in patients with oligosecretory and nonsecretory disease) and following patients with known multiple myeloma to both asess response to treatment and detect early relapse. Treatment of acute renal failure consists of good supportive care and anti-myeloma therapy. Introduction of novel agents (bortezomib, thalidomide, lenalidomide) has considerably improved outcome in patients with multiple myeloma and renal failure. Bortezomib-based chemotherapy with high-dose dexamethasone is now considered the first-line of therapy in these patients.

• Keywords: multipli mijelom; bubrežna insuficijencija; patogeneza bubrežne bolesti; dijagnostika; novi lijekovi
• Keywords (english): multiple myeloma; renal failure; pathogenesis of renal disease; diagnostics; novel agents
• Language: croatian
• URN:NBN: urn:nbn:hr:105:477089
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-04-04 11:52:18