Chinese General Practice ›› 2022, Vol. 25 ›› Issue (08): 952-956.DOI: 10.12114/j.issn.1007-9572.2021.01.504
Special Issue: 泌尿系统疾病最新文章合集
• Original Research • Previous Articles Next Articles
Clinicopathological Manifestations of Kidney Injury in Leukemia
Department of Nephrology,Peking University People's Hospital,Beijing 100044,China
*Corresponding author:YAN Yu,Associate chief physician;E-mail:yanyu@bjmu.edu.cn
Received:
2021-10-01
Revised:
2021-12-16
Published:
2022-03-15
Online:
2022-03-02
通讯作者:
燕宇
基金资助:
CLC Number:
WANG Yina, DONG Bao, LI Xin, SHAO Chunying, ZUO Li, WANG Mei, YAN Yu.
Clinicopathological Manifestations of Kidney Injury in Leukemia [J]. Chinese General Practice, 2022, 25(08): 952-956.
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2021.01.504
病例 | 一般资料 | 临床表现 | 超声检查结果肾脏长径(cm) | 实验室检查结果 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
性别 | 发病年龄(岁) | 原发病 | 治疗史 | 病程(月) | 肾外表现 | 合并症 | 尿红细胞计数(个/μl) | 尿蛋白定量(g/d) | 血白细胞计数(×109/L) | 血淋巴细胞百分比(%) | 血白蛋白(g/L) | 血肌酐(μmol/L) | M蛋白及自身抗体 | ||
1 | 男 | 19 | B-ALL | 异基因造血干细胞移植 | 12 | 无 | 无 | 13.5 | 2 | 10.96 | 10.6 | 17.7 | 22.1 | 106 | 无 |
2 | 男 | 30 | B-ALL | 异基因造血干细胞移植 | 11 | 肝、脾、淋巴结肿大 | 无 | 16.1 | 30 | 0.70 | 3.8 | 40.5 | 45.8 | 216 | 无 |
3 | 男 | 54 | B-CLL | 未治疗 | 7 | 肝、脾、淋巴结肿大 | 无 | 10.5 | 5 | 1.24 | 106.7 | 90.8 | 47.0 | 179 | 轻链κ阳性 |
4 | 男 | 57 | B-CLL | 未治疗 | 6 | 肝、脾、淋巴结肿大 | 高血压 | 11.6 | 128 | 7.52 | 22.1 | 84.2 | 30.3 | 192 | IgGλ阳性 |
5 | 男 | 73 | B-CLL | 未治疗 | 12 | 肝、脾、淋巴结肿大 | 高血压 | 未测量 | 33 | 1.65 | 3.9 | 62.5 | 34.5 | 122 | ANA滴度为1∶1 280,抗dsDNA抗体阳性 |
Table 1 General information,clinical manifestations,ultrasonic and laboratory examination results of five patients with kidney injury in leukemia
病例 | 一般资料 | 临床表现 | 超声检查结果肾脏长径(cm) | 实验室检查结果 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
性别 | 发病年龄(岁) | 原发病 | 治疗史 | 病程(月) | 肾外表现 | 合并症 | 尿红细胞计数(个/μl) | 尿蛋白定量(g/d) | 血白细胞计数(×109/L) | 血淋巴细胞百分比(%) | 血白蛋白(g/L) | 血肌酐(μmol/L) | M蛋白及自身抗体 | ||
1 | 男 | 19 | B-ALL | 异基因造血干细胞移植 | 12 | 无 | 无 | 13.5 | 2 | 10.96 | 10.6 | 17.7 | 22.1 | 106 | 无 |
2 | 男 | 30 | B-ALL | 异基因造血干细胞移植 | 11 | 肝、脾、淋巴结肿大 | 无 | 16.1 | 30 | 0.70 | 3.8 | 40.5 | 45.8 | 216 | 无 |
3 | 男 | 54 | B-CLL | 未治疗 | 7 | 肝、脾、淋巴结肿大 | 无 | 10.5 | 5 | 1.24 | 106.7 | 90.8 | 47.0 | 179 | 轻链κ阳性 |
4 | 男 | 57 | B-CLL | 未治疗 | 6 | 肝、脾、淋巴结肿大 | 高血压 | 11.6 | 128 | 7.52 | 22.1 | 84.2 | 30.3 | 192 | IgGλ阳性 |
5 | 男 | 73 | B-CLL | 未治疗 | 12 | 肝、脾、淋巴结肿大 | 高血压 | 未测量 | 33 | 1.65 | 3.9 | 62.5 | 34.5 | 122 | ANA滴度为1∶1 280,抗dsDNA抗体阳性 |
病例 | 治疗方案 | 随访时间 | 随访方式 | 随访结果 |
---|---|---|---|---|
1 | RCOP | 2个月 | 门诊 | 血肌酐:56 μmol/L,尿蛋白定量:11.20 g/d,肾脏长径恢复至11 cm |
2 | 激素 | 1周 | 门诊 | 血肌酐:205 μmol/L,肾脏长径无变化 |
3 | 伊布替尼 | 42个月 | 门诊 | 血肌酐:176 μmol/L,尿蛋白定量:1.09 g/d |
4 | 化疗(具体不详) | 51个月 | 门诊 | 血肌酐:126 μmol/L,尿蛋白(++) |
5 | RCOP | 80个月 | 门诊 | 血肌酐:150 μmol/L,尿蛋白(+) |
Table 2 Therapeutic regimen and follow-up of five patients with kidney injury in leukemia
病例 | 治疗方案 | 随访时间 | 随访方式 | 随访结果 |
---|---|---|---|---|
1 | RCOP | 2个月 | 门诊 | 血肌酐:56 μmol/L,尿蛋白定量:11.20 g/d,肾脏长径恢复至11 cm |
2 | 激素 | 1周 | 门诊 | 血肌酐:205 μmol/L,肾脏长径无变化 |
3 | 伊布替尼 | 42个月 | 门诊 | 血肌酐:176 μmol/L,尿蛋白定量:1.09 g/d |
4 | 化疗(具体不详) | 51个月 | 门诊 | 血肌酐:126 μmol/L,尿蛋白(++) |
5 | RCOP | 80个月 | 门诊 | 血肌酐:150 μmol/L,尿蛋白(+) |
病例来源 | 发表时间 | 发病年龄(岁) | 性别 | 原发病 | 治疗方案 | 病程 | 临床表现 | 肾脏影像学表现 | 肾组织病理变化 | 骨髓象 | 预后 |
---|---|---|---|---|---|---|---|---|---|---|---|
文献[ | 2010年 | 46 | 男 | ALL (L2型) | HSCT | 28个月 | 肾功能不全 | 长径为21 cm | 间质弥漫细胞浸润,细胞异型性 | ALL复发 | 感染性休克、死亡 |
文献[ | 2010年 | 16 | 男 | pre-B-ALL | 化疗 | 7个月 | 血尿 | 左肾占位 | 弥漫淋巴母细胞浸润 | 正常 | 肾功能不全 |
文献[ | 2003年 | 29 | 男 | T-ALL | 化疗 | 3周 | 急性肾损伤 | 长径为15 cm | 间质弥漫肿瘤细胞浸润 | 正常 | 肾功能恢复正常 |
文献[ | 2006年 | 6 | 男 | com-ALL | HSCT | 12个月 | 左侧腰部肿物 | 左肾占位 | 弥漫淋巴母细胞浸润 | 正常 | 全身感染、多脏器功能衰竭、死亡 |
3 | 男 | pre-B-ALL | HSCT | 10个月 | 左侧腰痛 | 左肾占位 | 间质弥漫肿瘤细胞浸润 | 正常 | 未提及 | ||
5 | 男 | com-ALL | HSCT | 11个月 | 右肾肿物 | 右肾占位 | 未提及 | 正常 | 缓解 | ||
文献[ | 2000年 | 16 | 女 | ALL | 化疗 | 32个月 | 左肾肿物 | 左肾占位 | 未提及 | 正常 | 完全缓解 |
文献[ | 2013年 | 62 | 女 | B-ALL | HSCT | 4个月 | 急性肾损伤 | 双肾肿大 | 间质弥漫肿瘤细胞浸润 | ALL复发 | 多部位髓外复发 |
文献[ | 2013年 | 65 | 男 | pre-B-ALL | HSCT | 3个月 | 无 | 未提及 | 间质弥漫肿瘤细胞浸润 | 未提及 | 髓外复发、死亡 |
文献[ | 2017年 | 40 | 男 | ALL | HSCT | 34个月 | 左下腹痛 | 左肾占位 | 间质弥漫肿瘤细胞浸润 | 正常 | 未提及 |
本研究病例1 | 待发表 | 19 | 男 | B-ALL | HSCT | 12个月 | 急性肾损伤 | 双肾肿大 | Ⅰ期膜性肾病、间质弥漫肿瘤细胞浸润 | 正常 | 肾功能恢复正常,尿蛋白无改善 |
本研究病例2 | 待发表 | 30 | 男 | B-ALL | HSCT | 11个月 | 急性肾损伤 | 双肾肿大 | 间质弥漫肿瘤细胞浸润 | ALL复发 | 未提及 |
Table 3 Clinical,pathological manifestations and prognosis of reported cases with extramedullary recurrence of leukemia
病例来源 | 发表时间 | 发病年龄(岁) | 性别 | 原发病 | 治疗方案 | 病程 | 临床表现 | 肾脏影像学表现 | 肾组织病理变化 | 骨髓象 | 预后 |
---|---|---|---|---|---|---|---|---|---|---|---|
文献[ | 2010年 | 46 | 男 | ALL (L2型) | HSCT | 28个月 | 肾功能不全 | 长径为21 cm | 间质弥漫细胞浸润,细胞异型性 | ALL复发 | 感染性休克、死亡 |
文献[ | 2010年 | 16 | 男 | pre-B-ALL | 化疗 | 7个月 | 血尿 | 左肾占位 | 弥漫淋巴母细胞浸润 | 正常 | 肾功能不全 |
文献[ | 2003年 | 29 | 男 | T-ALL | 化疗 | 3周 | 急性肾损伤 | 长径为15 cm | 间质弥漫肿瘤细胞浸润 | 正常 | 肾功能恢复正常 |
文献[ | 2006年 | 6 | 男 | com-ALL | HSCT | 12个月 | 左侧腰部肿物 | 左肾占位 | 弥漫淋巴母细胞浸润 | 正常 | 全身感染、多脏器功能衰竭、死亡 |
3 | 男 | pre-B-ALL | HSCT | 10个月 | 左侧腰痛 | 左肾占位 | 间质弥漫肿瘤细胞浸润 | 正常 | 未提及 | ||
5 | 男 | com-ALL | HSCT | 11个月 | 右肾肿物 | 右肾占位 | 未提及 | 正常 | 缓解 | ||
文献[ | 2000年 | 16 | 女 | ALL | 化疗 | 32个月 | 左肾肿物 | 左肾占位 | 未提及 | 正常 | 完全缓解 |
文献[ | 2013年 | 62 | 女 | B-ALL | HSCT | 4个月 | 急性肾损伤 | 双肾肿大 | 间质弥漫肿瘤细胞浸润 | ALL复发 | 多部位髓外复发 |
文献[ | 2013年 | 65 | 男 | pre-B-ALL | HSCT | 3个月 | 无 | 未提及 | 间质弥漫肿瘤细胞浸润 | 未提及 | 髓外复发、死亡 |
文献[ | 2017年 | 40 | 男 | ALL | HSCT | 34个月 | 左下腹痛 | 左肾占位 | 间质弥漫肿瘤细胞浸润 | 正常 | 未提及 |
本研究病例1 | 待发表 | 19 | 男 | B-ALL | HSCT | 12个月 | 急性肾损伤 | 双肾肿大 | Ⅰ期膜性肾病、间质弥漫肿瘤细胞浸润 | 正常 | 肾功能恢复正常,尿蛋白无改善 |
本研究病例2 | 待发表 | 30 | 男 | B-ALL | HSCT | 11个月 | 急性肾损伤 | 双肾肿大 | 间质弥漫肿瘤细胞浸润 | ALL复发 | 未提及 |
[1] | 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)恶性血液病诊疗指南2020版[M]. 北京:人民卫生出版社,2020:567-587. |
[2] | DETRAIT M, MEUNIER C, ROY D C,et al. Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation[J]. Bone Marrow Transplant,2010,45(5):953-954. DOI:10.1038/bmt.2009.246. |
[3] | DE A, MENELL J S. Isolated renal relapse in acute lymphoblastic leukemia[J]. J Pediatr Hematol Oncol,2010,32(2):150-151. DOI:10.1097/MPH.0b013e3181b7eaff. |
[4] | DE KEULENAER B, VAN OUTRYVE S, DE BACKER A,et al. Symptomatic lactic acidosis due to relapse of T-cell acute lymphoblastic leukaemia in the kidney[J]. Nephrol Dial Transplant,2003,18(6):1214-1216. DOI:10.1093/ndt/gfg053. |
[5] | HUCK K, LAWS H J, MEISEL R,et al. Three cases of renal relapse after allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia[J]. Haematologica,2006,91(5 ):ECR07. |
[6] | KEBAILI K, MANEL A M, CHAPELON C,et al. Renal enlargement as presentation of isolated renal relapse in childhood leukemia[J]. J Pediatr Hematol Oncol,2000,22(5):454-456. DOI:10.1097/00043426-200009000-00014. |
[7] | SKEITH L, LAZO-LANGNER A, MANGEL J. Kidney and pancreatic extramedullary relapse in adult acute lymphoblastic leukemia:a case report and review of the literature[J]. Case Rep Hematol,2013,2013:637264. DOI: 10.1155/2013/637264. |
[8] | TANAKA Y, YAKUSHIJIN K, TAKAFUTA T. Enlargement of bilateral kidneys by infiltration of leukemic cells in acute lymphoblastic leukemia at relapse after allogeneic hematopoietic stem cell transplantation[J]. Int J Hematol,2013,98(5):513-514. DOI:10.1007/s12185-013-1447-0. |
[9] | 付成伟,陈立军,王亚林,等. 急性白血病异基因造血干细胞移植后髓外肾复发一例报告[J]. 中华泌尿外科杂志,2017,38(4):313. DOI:10.3760/cma.j.issn.1000-6702.2017.04.021. |
[10] | LUCIANO R L, BREWSTER U C. Kidney involvement in leukemia and lymphoma[J]. Adv Chronic Kidney Dis,2014,21(1):27-35. DOI:10.1053/j.ackd.2013.07.004. |
[11] | WANCHOO R, BERNABE RAMIREZ C, BARRIENTOS J,et al. Renal involvement in chronic lymphocytic leukemia[J]. Clin Kidney J,2018,11(5):670-680. |
[12] | DA'AS N, POLLIACK A, COHEN Y,et al. Kidney involvement and renal manifestations in non-Hodgkin's lymphoma and lymphocytic leukemia:a retrospective study in 700 patients[J]. Eur J Haematol,2001,67(3):158-164. DOI:10.1034/j.1600-0609.2001.5790493.x. |
[13] | STRATI P, NASR S H, LEUNG N,et al. Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis:the Mayo Clinic experience[J]. Haematologica,2015,100(9):1180-1188. DOI:10.3324/haematol.2015.128793. |
[14] | JHAVERI K D, SHAH H H, CALDERON K,et al. Glomerular diseases seen with cancer and chemotherapy:a narrative review[J]. Kidney Int,2013,84(1):34-44. DOI:10.1038/ki.2012.484. |
[15] | KOWALEWSKA J, NICOSIA R F, SMITH K D,et al. Patterns of glomerular injury in kidneys infiltrated by lymphoplasmacytic neoplasms[J]. Hum Pathol,2011,42(6):896-903. DOI:10.1016/j.humpath.2010.09.009. |
[16] | SPALDING E M, WATKINS S, WARWICKER P. Minimal-change glomerulonephritis and chronic lymphocytic leukaemia[J]. Nephron,2001,88(3):283-284. DOI:10.1159/000046006. |
[17] | EDREES F, BLACK R M, LEB L,et al. Minimal change disease:a case report of an unusual relationship[J]. Saudi J Kidney Dis Transpl,2016,27(4):816-820. DOI:10.4103/1319-2442.185271. |
[18] | ALZAMORA M G, SCHMIDLI M, HESS U,et al. Minimal change glomerulonephritis in chronic lymphocytic leukemia:pathophysiological and therapeutic aspects[J]. Onkologie,2006,29(4):153-156. |
[19] | ZHANG N, ZHAO P, SHRESTHA A,et al. A higher frequency of CD4+CXCR4+ T follicular helper cells in adult patients with minimal change disease[J]. Biomed Res Int,2014,2014:836157. DOI:10.1155/2014/836157. |
[20] | JHAVERI K D, SHAH H H, PATEL C,et al. Glomerular diseases associated with cancer,chemotherapy,and hematopoietic stem cell transplantation[J]. Adv Chronic Kidney Dis,2014,21(1):48-55. DOI:10.1053/j.ackd.2013.08.003. |
[21] | BECK L H Jr. Membranous nephropathy and malignancy[J]. Semin Nephrol,2010,30(6):635-644. DOI:10.1016/j.semnephrol.2010.09.011. |
[22] | SHI J M, MENG X J, LUO Y,et al. Clinical characteristics and outcome of isolated extramedullary relapse in acute leukemia after allogeneic stem cell transplantation:a single-center analysis[J]. Leuk Res,2013,37(4):372-377. DOI:10.1016/j.leukres.2012.12.002. |
[23] | FREYER D R, DEVIDAS M, LA M,et al. Postrelapse survival in childhood acute lymphoblastic leukemia is independent of initial treatment intensity:a report from the Children's Oncology Group[J]. Blood,2011,117(11):3010-3015. DOI:10.1182/blood-2010-07-294678. |
[24] | GE L, YE F, MAO X,et al. Extramedullary relapse of acute leukemia after allogeneic hematopoietic stem cell transplantation:different characteristics between acute myelogenous leukemia and acute lymphoblastic leukemia[J]. Biol Blood Marrow Transplant,2014,20(7):1040-1047. DOI:10.1016/j.bbmt.2014.03.030. |
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