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Multiples Myelom

Renale Beteiligung und hyperkalzämische Krise

Multiple Myeloma

Renal involvement and hypercalcemic crisis

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Die renale Beteiligung beim Multiplen Myelom (MM) beträgt zum Zeitpunkt der Diagnosestellung 20–50 %. Diese Schwankungen werden durch unterschiedliche Patientengruppen und der Verwendung unterschiedlicher Definitionen für die Niereninsuffizienz beim MM bedingt. Konsequent sollte die glomeruläre Filtrationsrate (GFR) zur Abschätzung der Nierenfunktion beim MM verwendet werden. Das Serumkreatinin ist eine mit großen Schwankungen belegte Laborkomponente. Im Zeitalter der konventionellen Chemotherapie war die Niereninsuffizienz beim MM mit einer sehr schlechten Prognose eines medianen Überlebens von etwa 2 Jahren vergesellschaftet. Die Möglichkeit, neue Antimyelommedikamente einzusetzen, hat eine Verdopplung des Überlebens beim MM bewirkt. Die schwere Niereninsuffizienz ist weiterhin assoziiert mit einem erhöhten Risiko für frühe Todesfälle. Die konsequente Therapie mit einer daraus folgenden schnellen Reduktion der Tumormasse ist entscheidend für die Erholung der Nierenfunktion beim MM.

Abstract

20–50 % of patients with multiple myeloma have renal involvement at the time of diagnosis. These variations are caused by different patient groups and the use of different definitions of renal impairment. The glomerular filtration rate (GFR) should be used consistently to determine renal function, as serum creatinine fluctuates too much. During the age of conventional chemotherapy patients with renal involvement had a very bad prognosis, with a median survival of about 2 years. The treatment opportunities with new drugs have resulted in a doubling of the overall survival. Severe kidney insufficiency is also associated with an increased risk of early mortality. Consistent therapy is crucial for fast shrinkage of the tumor mass and the recovery of renal function.

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Authors and Affiliations

  1. Medizinische Klinik V, Universitätsklinikum Heidelberg und Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    H. Goldschmidt

  2. Innere Medizin II, Universitätsklinikum und Myelomzentrum Tübingen, Tübingen, Deutschland

    K. Weisel

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  1. H. Goldschmidt
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  2. K. Weisel
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Correspondence to H. Goldschmidt.

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Interessenkonflikt

H. Goldschmidt und K. Weisel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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M. Zeier, Heidelberg

J. Hoyer, Marburg

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Goldschmidt, H., Weisel, K. Multiples Myelom. Nephrologe 11, 28–33 (2016). https://doi.org/10.1007/s11560-015-0031-4

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  • DOI: https://doi.org/10.1007/s11560-015-0031-4

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