Sugimoto Toshiro, Ito Jun, Takeda Naoko, Gasyu Ippei, Okazaki Tsutomu, Sakaguchi Masayoshi, Osawa Norihisa, Tanaka Yuki, Oka Kazumasa, Uzu Takashi, Kashiwagi Atsunori
Department of Medicine, Shiga University of Medical Science, Seta, Otsu, Shiga 5202192, Japan.
Am J Med Sci. 2008 Jun;335(6):495-8. doi: 10.1097/MAJ.0b013e3181571f7e.
Castleman's disease is a rare atypical lymphoproliferative disorder. Renal manifestations, such as proteinuria, hematuria, and renal dysfunction, are common in Castleman's disease; however, a nephrotic syndrome rarely occurs. We have encountered an unusual case of Castleman's disease of the plasma cell type characterized by nephrotic syndrome because of glomerulopathy mimicking membranoproliferative glomerulonephritis. Our patient showed higher levels of circulating cytokines (interleukin-6/vascular endothelial cell-derived growth factor), the glomerular lesions not associated with immunocomplex deposition, and the resolution of nephrotic syndrome after successful corticosteroids therapy resulting in a decline in cytokines levels, thereby implicating a cytokine-induced glomerular cell injury/activation as a possible cause of the glomerular pathological changes in this case.
卡斯特曼病是一种罕见的非典型淋巴增殖性疾病。蛋白尿、血尿和肾功能不全等肾脏表现在卡斯特曼病中很常见;然而,肾病综合征很少发生。我们遇到了一例不寻常的浆细胞型卡斯特曼病,其特征为肾病综合征,病因是类似膜增生性肾小球肾炎的肾小球病变。我们的患者循环细胞因子(白细胞介素-6/血管内皮细胞衍生生长因子)水平较高,肾小球病变与免疫复合物沉积无关,成功的皮质类固醇治疗后肾病综合征缓解,细胞因子水平下降,从而提示细胞因子诱导的肾小球细胞损伤/激活可能是该病例肾小球病理变化的原因。