多发性骨髓瘤合并肾损伤中西医结合治疗研究进展OA

Multiple myeloma(MM)is a clonal plasma cell disorder characterized by uncontrolled proliferation of malignant plasma cells,which secrete aberrant monoclonal immunoglobulins and free light chains(FLCs)that mediate end-organ damage through direct tissue toxicity.Renal impairment represents a predominant extramedullary complication of MM,with cast nephropa-thy(CN)identified as the hallmark lesion resulting from FLC precipitation in renal tubules.Clinically,MM-associated nephrop-athy manifests as two distinct entities:acute kidney injury(AKI)triggered by tubular cast obstruction,and chronic kidney dis-ease(CKD)secondary to progressive interstitial fibrosis.While pharmacological interventions targeting plasma cell clones remain the cornerstone of management,evolving evidence from randomized controlled trials(RCTs)has revealed the potential renopro-tective effects of traditional Chinese medicine(TCM),particularly in mitigating FLC-induced tubular epithelial cell apoptosis via modulation of ER stress pathways.Timely diagnosis through serum FLC quantification and renal biopsy,combined with mecha-nism-guided integrated therapies,significantly improves renal outcomes.This review delineates the molecular mechanisms under-lying MM-related nephropathy and critically appraises current understanding of synergistic therapeutic strategies combining pro-teasome inhibitors with TCM-derived bioactive compounds.