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Timočki medicinski glasnik
2013, vol. 38, br. 1, str. 40-49
jezik rada: srpski
vrsta rada: pregledni članak

Mijelomski bubreg - etiopatogeneza, dijagnostika i lečenje
aKC "Kragujevac", Centar za nefrologiju i dijalizu, Klinika za urologiju i nefrologiju, Kragujevac
bKC "Kragujevac", Klinika za hematologiju, Kragujevac
cZC "Zaječar", Zaječar, Odeljenje za hemodijalizu

e-adresa: aca96@eunet.rs

Projekat

Analiza strukture troškova i uticaja na zdravstveni budžet Republike Srbije epidemiološki najmasovnijih i/ili najskupljih oboljenja i procena odnosa troškovi / efektivnost / korisnost medicinskih intervencija (MPNTR - 175014)
Preklinička ispitivanja bioaktivnih supstanci (MPNTR - 41010)

Sažetak

Multipli mijelom je maligno oboljenje monoklonskih plazma ćelija, koje se karakteriše povećanom i nekontrolisanom proliferacijom ovih ćelija u kostnoj srži i povećanim stvaranjem monoklonskih proteina. Rad je imao za cilj da analizira etiopatogenezu mijelomskog bubrega i da ukaže na klinički značaj njegovog ranog otkrivanja i pravovremenog lečenja. Analizirani su stručni radovi i kliničke studije koje se bave etiopatogenezom, dijagnostikom i lečenjem multiplog mijeloma i mijelomskog bubrega. Multipli mijelom čini 10% svih hematoloških maligniteta. U 50% bolesnika javlja se oštećenje bubrega: nefropatija izazvana cilindrima (mijelomski bubreg), bolest deponovanja lakih lanaca i amiloidoza bubrega izazvana lakim lancima. Monoklonski slobodni laki lanci deluju direktno citotoksično na epitelne ćelije proksimalnih tubula, podstiču stvaranje i oslobađanje prozapaljenskih citokina u ovim ćelijama, a to za posledicu ima nakupljanje mononuklearnih ćelija u intersticijumu bubrega i ožiljavanje tubulointersticijuma. Smanjenje koncentracije monoklonskih slobodnih lakih lanaca u serumu bolesnika, u prve tri nedelje, za više od 50% doprinosi oporavku funkcije bubrega. Ovo smanjenje se postiže istovremenom primenom novih hemioterapijskih agenasa (talidomid, bortezomib, lenalidomid i dr.) i terapijskih postupaka za direktno odstranjivanje slobodnih lakih lanaca iz seruma bolesnika (plazmafereza, HCO-hemodijaliza). Rano otkrivanje i pravovremeno lečenje multiplog mijeloma sa akutnim oštećenjem bubrega oporavlja funkciju bubrega i popravlja ishod ovih bolesnika.

Ključne reči

multipli mijelom; mijelomski bubreg; strategija lečenja

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