Peña de la Vega Lourdes, Fervenza Fernando C, Lager Donna, Habermann Thomas, Leung Nelson
Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ren Fail. 2005;27(4):485-9. doi: 10.1081/jdi-65397.
Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world and is characterized by a progressive accumulation of functionally incompetent monoclonal lymphocytes. Renal involvement has been described in CLL but is uncommon. Granulomatous interstitial nephritis is a rare but characteristic hallmark of certain diseases such as sarcoidosis and tuberculosis. These epithelial reactions have also been reported with medications, infections, inflammation, Wegener's granulomatosis, and jejunoileal bypass. We present a 74-year-old woman with a stage 0 chronic lymphocytic leukemia who developed acute renal failure following the initiation of alendronate. The renal biopsy revealed an acute granulomatous interstitial nephritis. Infectious and inflammatory etiologies were ruled out. Hemodialysis was required despite discontinuation of all medications. Partial recovery of renal function occurred after 6 weeks of prednisone therapy and cyclophosphamide. This report describes a unique case of acute granulomatous interstitial nephritis and leukemic cell kidney infiltration by CLL.
慢性淋巴细胞白血病（CLL）是西方世界最常见的白血病，其特征是功能不全的单克隆淋巴细胞进行性积聚。CLL患者存在肾脏受累情况，但并不常见。肉芽肿性间质性肾炎是某些疾病（如结节病和结核病）罕见但具有特征性的标志。这些上皮反应也见于药物、感染、炎症、韦格纳肉芽肿病和空肠回肠旁路术后。我们报告一例74岁0期慢性淋巴细胞白血病女性患者，在开始使用阿仑膦酸盐后发生急性肾衰竭。肾活检显示为急性肉芽肿性间质性肾炎。排除了感染性和炎症性病因。尽管停用了所有药物，仍需要进行血液透析。泼尼松治疗和环磷酰胺治疗6周后肾功能部分恢复。本报告描述了一例急性肉芽肿性间质性肾炎合并CLL白血病细胞肾脏浸润的独特病例。
