白if病肾损害诊 断
白血病引起肾脏浸润非常常见，但多数无临床表现，故在白血病的诊治过程中应密切观察，一 日出现尿异常(蛋白乐血尿将性糖尿尿溶苗南升高等)、特区疼痛或种块时，应及时做行脏B招检在有助于确诊”，必要时可行得话粉 白血病肾损害的诊断，须满足如下3个标准”:0肾胜病表现出现在白血病确诊之前、同时或之后;2 肾班闲表现随着白血病的缓解而缓解;自血病复发后肾胜病再次出现或加重;③拎球生白 阳性或有M带。 中 白血病化疗前及化疗中检查血尿酸、乐保酸、东常规、特功能及血电解质等。可早期发现床酸背病及电解质素乱。
六、治疗与预防11
主要治疗白血病、防止白由病背航浸润及保酸骨构。
1.白南病的治疗 根据白血病的类型采用不同的化疗方案(可参阅血液病专业书籍)，由于同时存在多系统的病变和影响疗效预后的多种因素，通常需与血液病专科医师共同协商后制订合理治疗方案。随着白血病治疗缓解，开脏病可相应好转。发生背衰者，可考虑骨驻替代治疗。
2.防止屎酸骨病首先避免脱水 及酸性尿等诱发展酸沉积因素，化疗前至少三天开始用别噤岭醇。控制血尿险和尿屎酿在正常范围:化疗期间应补充液体碱化尿液.使尿pH维特在6.2- 6.8之间，已发生屎酸开病时除继续用别嘌岭醇外，还需加喊性药及补液以减少尿酸的沉积。
(周福德 刘玉春)
参考文献
1王海燕，刘玉春，潘辑圣白直病骨损青王海燕督脏病学。第2版北京人民卫牛出版社。1991015 1018.
2. NorsHI,Wiene The reme esion in lnkemin AmJ Mad 1.1616241.512518
古建乃，罗安秦，丘使世、等 白血病155例病理解到资料分析.19.18.9396.
”Baros M,lane W.Come GA.e al An autopsy sudy of 1206 acute and chrenic leukemin (195801982). Caneer.1987 60.827-837.
”张素芬，王海林。郭步云，等、白直病保能报害的临床及病理观察。中华内科杂志，99231:19151.187.
Ronco PML Parntepestir lomeruipathie. Kidhney 91995.5535
7. Ssil Mw. HpinsnJ.. Ciore SD,et al. Autoinmaune pheomens in ptients with myolelyplasties sydrome and chronic myelomonocytic leukemia L.euk Lymphonw 2002,43;2083 2002
8. Ikee R.Kobeyach S.Hmn N.et a Arshiabsis ascitd with chromie bouyhoeyti lakemin Angdod,2005,12;131 134.
9. Salding EM,Wakins S, and WarweckerP. Mimimal change loerelomphrsiss and chrcaic lmphoeytieleukemia Nephron,200 88,283 284.
10.7Meyers CM,Seef L.B. Stehnman Breen CO.et al Hepatis C and remal disesean uplure. Am ] Kid
ney Ds 2003，12:631-657.
1. Mallouk A.Pham PT .Plam PC Comurenl FSCS and Hadgkin's lymphoema: ce repor and iersture
review on the link between nephritic glomerulopathies and bemobogial maligmancies. Clin Exp Neph-
rul,2005.10:284 289.
12. Tsinberidu AM. Keating M. Hyperuricenic syndiromnes in caner patients. Conurib Nephrol, 005，
147:47-60.
13. Montein P.lorrwo IMarinG.eral Tumor byis syndroue in pticnts with acule myebid ekemine
idntfiaticio af risk fnctors and deekapet od a prdieivne nodel Harmtolgin ,2008.93.67-74.14. Nlkumurn M.Chishi A.Winanate R.e al Adulk Teedl lukernia wth byealanio indknd metnstati aldr
fiaion in the humgs due 10 production af pantyroioi elutled protein Intem Md.2001.40:409 41315. Muggin FM.Hemrumn HO.Farhargi M,etal. Lyoymurin and renel tubular dsfunction im mwuncyt
i and myelomomsagytic leukerni. Am J Med, 1969,47.351366.
6. 11 Wideramn议，Aibmsn PC. Undersanding and mansing metotreute ephotosicie Chcolor
835s1.2006.11.694-703.
. XienJC,Walr Matralle R.RuckP.et al Ranal imvolveren in mepaifentive and ymghopoddemaiwe
diorders Astuly of atopey ases Gen Dhngn Pthal, 9919117 153.
18. HilPA.FirkinF.Dwyer KM.et al. Menbrprlfentiree lumuwuewephritis in ssi with chro-ic ympheynie luksemin a repor of three cses. uabiogy.223 38-13.
19.Diusol B, Brunet P.Vace-oponat H.e al Crecentic plomendoephritits wih antinutopbil cytePlasnic anthedies 8ocited with chronic lymphoeyie leukemin, Nephrol Dial Transplant,1997.12:785786.
20. Sato A.Imsizumi M.Chkaoka S,et al. Acute renal ailure due 10 leukemie cell nfilteaion olloolo byrelapse a1 multiple extramedullary sites in a child with acute lymphoblastic lukemi Leuk L.ympboma,2004,45;825 82B.
21. DudaJ and Zoger S. Presentation of M4 acute myeloid leukemia in anuria renal falure with hyperuricemia and enlarged kidneys. ] Pediatr Hematol Onscol,2002,24:55 58.
22.陈书长.急性淋巴细胞白血病缓解5年，多饮、多果、头痛呕吐，中华内科杂志1991，30;122.23. Olgar S, Yetgin S,Cetin M.et sl. Electrolyte abnomalities ar disgnosis of scute lymphocytic leukenia
may be a clue for remal damage in loang term perid. 」Pediatr Hematol Cnool,2005.27 :202 206.24. Boueva A,Bouvier R. Precursor Bcell lymphoblastic leukemis as a cause of a bilsteral nephcomcgaly.Pediatr Nephrol,2005 ,20:679 682.
返回列表