Feinfeld D A, D'Agati V, Dutcher J P, Werfel S B, Lynn R I, Wiernik P H
Department of Medicine, Nassau County Medical Center, East Meadow, N.Y.
Am J Nephrol. 1991;11(6):489-92. doi: 10.1159/000168365.
A patient receiving adoptive immunotherapy with recombinant interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells for metastatic melanoma developed acute renal insufficiency out of proportion to the decrease in her renal perfusion after 4 days of receiving IL-2. On the 8th day of IL-2 and the 3rd day of LAK cell infusion she expired suddenly from an acute intra-abdominal hemorrhage due to rupture of a metastasis. Postmortem examination of the kidneys showed an interstitial infiltrate consisting largely of lymphocytes and concomitant tubulitis. Immunoperoxidase staining of the infiltrating cells with a panel of lymphocyte-specific monoclonal antibodies showed the majority of cells to be T lymphocytes (70-75%), with a more focal infiltrate of B lymphocytes (25-30%) and rare monocytes, granulocytes and natural killer cells. This patient represents the first reported case of acute interstitial nephritis associated with IL-2 immunotherapy. Our finding is consistent with the hypothesis that the acute renal failure that accompanies this therapy may sometimes be due to intrinsic renal disease as well as the usual pre-renal failure. Nephritis may be caused by IL-2-mediated effects on lymphocytes, resulting in renal parenchymal infiltration.
一名接受重组白细胞介素-2（IL-2）和淋巴因子激活的杀伤细胞（LAK）进行过继性免疫治疗的转移性黑色素瘤患者，在接受IL-2治疗4天后出现了与肾脏灌注减少不成比例的急性肾功能不全。在使用IL-2的第8天和输注LAK细胞的第3天，她因一处转移灶破裂导致急性腹腔内出血而突然死亡。肾脏的尸检显示，间质浸润主要由淋巴细胞组成，并伴有肾小管炎。用一组淋巴细胞特异性单克隆抗体对浸润细胞进行免疫过氧化物酶染色显示，大多数细胞为T淋巴细胞（70 - 75%），B淋巴细胞有更局灶性的浸润（25 - 30%），罕见单核细胞、粒细胞和自然杀伤细胞。该患者是首例报道的与IL-2免疫治疗相关的急性间质性肾炎病例。我们的发现与这样的假说一致，即这种治疗伴随的急性肾衰竭有时可能是由于内在的肾脏疾病以及常见的肾前性肾衰竭。肾炎可能是由IL-2对淋巴细胞的介导作用引起的，导致肾实质浸润。
