Yahata N, Kawanishi Y, Okabe S, Kimura Y, Okada T, Otani M, Shimizu T, Nakao T, Ohyashiki K
First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
Am J Nephrol. 2000 Sep-Oct;20(5):402-7. doi: 10.1159/000013626.
A 66-year-old woman was admitted to our hospital for evaluation of edema of the extremities. Laboratory findings suggested that she had nephrotic syndrome and chronic lymphocytic leukemia (CLL). Renal biopsy (with PAM staining) showed a spike formation in the capillary wall. Immunofluorescent staining revealed deposition of immunoglobulin G (IgG) and the third component of complement in the glomerular basement membrane. Electron microscopy showed fibrillary deposits in the subepithelium. These findings indicated membranous glomerulonephritis (MGN). In addition, focal segmental sclerosis and interstitial lymphocytic infiltration were observed in the renal biopsy specimen. In CLL patients nephrotic syndrome occurs rarely. Even if the complication occurs, MGN is not frequent. Both diseases are suspected to occur in association with each other, and immunologic abnormality contributes to their coexistence. Although administration of prednisolone and endoxan improved leukocytosis, proteinuria was not sufficiently improved with combination therapy.
一名66岁女性因四肢水肿入院接受评估。实验室检查结果提示她患有肾病综合征和慢性淋巴细胞白血病（CLL）。肾活检（采用PAM染色）显示毛细血管壁有钉突形成。免疫荧光染色显示免疫球蛋白G（IgG）和补体第三成分在肾小球基底膜沉积。电子显微镜检查显示上皮下有纤维状沉积物。这些发现提示为膜性肾小球肾炎（MGN）。此外，在肾活检标本中观察到局灶节段性硬化和间质淋巴细胞浸润。在CLL患者中，肾病综合征很少发生。即使出现并发症，MGN也不常见。怀疑这两种疾病相互关联发生，免疫异常促成了它们的共存。尽管使用泼尼松龙和环磷酰胺改善了白细胞增多，但联合治疗对蛋白尿的改善并不充分。
