Yoshimura Kazunobu, Joh Kensuke, Kitamura Hiroshi, Takahashi Yasuhito, Yokote Shinya, Kasai Kenji, Hosoya Tatsuo
Department of Nephrology, Fuji City General Hospital, Shizuoka, Japan.
Clin Exp Nephrol. 2008 Dec;12(6):522-6. doi: 10.1007/s10157-008-0099-5. Epub 2008 Nov 1.
A 59-year-old man underwent total gastrectomy and splenectomy for gastric cancer 14 months before admission. The pathological diagnosis was neuroendocrine carcinoma of the stomach. Eight months after the operation, systemic chemotherapy with irinotecan and cisplatin was started because of multiple metastases to lymph nodes. After two courses of chemotherapy, renal function continued to decline. Renal biopsy showed acute tubular necrosis with cast formation, where needle crystallization was found. These clinicopathological findings suggested that tumor lysis syndrome was the cause of acute renal insufficiency. Moreover, diffuse, global bubbling and focal segmental spike formation were revealed by periodic acid-silver methenamine stain in the glomerular basement membrane. Electron microscopy showed an infolding of the cytoplasm of podocytes into the basal basement membrane and spotty electron-lucent areas. These ultrastructural findings, but not epimembranous deposits, corresponded with the bubbling on PAM staining. The present case was a rare case of glomerulopathy associated with podocytic infolding, which was not associated with collagen disease but with tumor lysis syndrome.
一名59岁男性在入院前14个月因胃癌接受了全胃切除术和脾切除术。病理诊断为胃神经内分泌癌。术后8个月，因淋巴结多发转移开始接受伊立替康和顺铂的全身化疗。两个疗程的化疗后，肾功能持续下降。肾活检显示急性肾小管坏死伴管型形成，发现针状结晶。这些临床病理表现提示肿瘤溶解综合征是急性肾功能不全的原因。此外，高碘酸-银甲胺染色显示肾小球基底膜弥漫性、整体性气泡形成及局灶节段性钉突形成。电子显微镜检查显示足细胞胞质内陷至基底膜，并有散在的电子透亮区。这些超微结构表现与高碘酸-银甲胺染色上的气泡形成相符，但与膜性沉积物无关。本病例是一例罕见的与足细胞内陷相关的肾小球病，其与胶原病无关，而是与肿瘤溶解综合征有关。
