Penatalaksanaan Kausatif untuk Memperbaiki Fungsi Ginjal Penderita Myeloma Multiple

Prasetio Kirmawanto

Abstract


Gangguan fungsi ginjal adalah salah satu komplikasi pada myeloma multiple (MM), suatu keganasan sel plasma. Penurunan laju filtrasi glomerulus/Glomerulus Filtration Rate (GFR) terjadi hingga 50% pasien baru terdiagnosa MM dan 9% memerlukan dialysis. Gagal ginjal penderita MM disebut ginjal myeloma dengan penyebab kompleks, akibat langsung maupun tidak langsung dari MM serta dari pengobatan keluhan MM. Laporan ini memaparkan pengelolaan kasus MM dengan faktor penyulit gangguan fungsi ginjal. Lakilaki 48 tahun dengan keluhan utama nyeri punggung sejak satu bulan, didiagnosa mieloma multipel disertai komplikasi ginjal mieloma. Kriteria Durie dan Salmon tingkat penyakit Stadium IIIB. Penatalaksanaan kausatif dengan regimen melphalan dan prednison, khemoterapi konvensional untuk MM. Regimen kemoterapi kombinasi tidak dipilih karena pertimbangan gangguan fungsi ginjal. Penatalaksanaan penurunan fungsi ginjal dengan memperbaiki status hidrasi, menghentikan pemberian obat nefrotoksik dan pemberian diet cukup protein. Terapi pendukung pemberian Bonefos untuk memperlambat proses osteolitik. Anemia diawal perawatan (Hb: 6 g/dL) diperbaiki dengan transfusi Packet Red Cell. Pasien dirawat 21 hari, menjalani satu kali khemoterapi terjadi perbaikan fungsi ginjal, diawal perawatan GFR: 18.45 mL/min menjadi 26.72 mL/ min diakhir perawatan. Pasien direncanakan khemoterapi 6 seri interval 28 hari. Penatalaksanaan kausatif kasus ini memberikan hasil yang baik, keluhan nyeri dirasakan sudah sangat berkurang dan fungsi ginjal relatif membaik.

Impaired kidney function is common complication in multiple myeloma (MM), a plasma cell malignancy. Glomerulus Filtration Rate (GFR) reduction in patients diagnosed MM occurs 50% and 9% requiring dialysis. Kidney failure in patients with MM called myeloma kidney, with complex cause. It’s may result directly or indirectly from MM and treatment of MM. This report describes management of MM with complications of impaired renal function. A man 48y suffering from backpain for a month with diagnosis: multiple myeloma with renal complications of myeloma. Stage IIIB according Durie and Salmon criteria. Causative management was done with melphalan and prednisone regimen, conventional chemotherapy for MM. Combination chemotherapy regimens were not selected considering renal function impairment. Management of decreasing kidney function by improving hydration status; discontinue nephrotoxic drugs and adequate protein diet. Bonefos therapy to slow the osteolytic process. Anemia at the beginning of treatment (Hb: 6 g/ dL) improved by Packet Red Cell transfusion. Renal function showed improvement after 21 days treatment and undergoing one chemotherapy. GFR pre-treatment 18:45 mL/min and post-treatment 26.72 mL/min. Patient was planned 6 series chemotherapy with 28 days interval. Causative management gives good results, where the perceived pain complaints were greatly reduced and kidney function is relatively improved.

Keywords


multiple myeloma; myeloma kidney; Durie-Salmon,; Glomerulus Filtration Rate; mieloma multipel; ginjal mieloma; Durie-Salmon; Glomerulus Filtration Rate

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