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master's thesis
Bubrežna insuficijencija u osoba s multiplim mijelomom
Zagreb: University of Zagreb, School of Medicine, 2017. urn:nbn:hr:105:477089
Petričević, Fran
University of Zagreb
School of Medicine
Department of Internal Medicine

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

Cite this document

Petričević, F. (2017). Bubrežna insuficijencija u osoba s multiplim mijelomom (Master's thesis). Zagreb: University of Zagreb, School of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:105:477089

Petričević, Fran. "Bubrežna insuficijencija u osoba s multiplim mijelomom." Master's thesis, University of Zagreb, School of Medicine, 2017. https://urn.nsk.hr/urn:nbn:hr:105:477089

Petričević, Fran. "Bubrežna insuficijencija u osoba s multiplim mijelomom." Master's thesis, University of Zagreb, School of Medicine, 2017. https://urn.nsk.hr/urn:nbn:hr:105:477089

Petričević, F. (2017). 'Bubrežna insuficijencija u osoba s multiplim mijelomom', Master's thesis, University of Zagreb, School of Medicine, accessed 27 December 2024, https://urn.nsk.hr/urn:nbn:hr:105:477089

Petričević F. Bubrežna insuficijencija u osoba s multiplim mijelomom [Master's thesis]. Zagreb: University of Zagreb, School of Medicine; 2017 [cited 2024 December 27] Available at: https://urn.nsk.hr/urn:nbn:hr:105:477089

F. Petričević, "Bubrežna insuficijencija u osoba s multiplim mijelomom", Master's thesis, University of Zagreb, School of Medicine, Zagreb, 2017. Available at: https://urn.nsk.hr/urn:nbn:hr:105:477089

Metadata
TitleBubrežna insuficijencija u osoba s multiplim mijelomom
Title (english)Renal failure in multiple myeloma patients
AuthorFran Petričević
MentorAna Planinc-Peraica (mentor)
Committee memberSlobodanka Ostojić-Kolonić (predsjednik povjerenstva)
Committee memberJasenka Markeljević (član povjerenstva)
Committee memberAna Planinc-Peraica (član povjerenstva)
GranterUniversity of Zagreb
School of Medicine
(Department of Internal Medicine)
Zagreb
Defense date and country2017-07-14, 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
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:105:477089
Study programmeTitle: Medicine
Study programme type: university
Study level: integrated undergraduate and graduate
Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resourceText
File originBorn digital
Access conditionsOpen access
Terms of useLicence In copyright icon
Created on2018-04-04 11:52:18