Sakai Kentaro, Usui Joichi, Kai Hirayasu, Hagiwara Masahiro, Morito Naoki, Saito Chie, Yoh Keigyou, Tsuruoka Syuichi, Hirayama Kouichi, Aita Kumi, Nagata Michio, Yamagata Kunihiro
Pathophysiology of Renal Diseases, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Nephrology, Tokyo Medical University Kasumigaura Hospital, Ami, Ibaraki, Japan.
Clin Exp Nephrol. 2009 Apr;13(2):174-178. doi: 10.1007/s10157-008-0120-z. Epub 2008 Dec 26.
A 29-year-old man with malignant lymphoma developed membranous nephropathy (MN) after allogeneic bone-marrow transplantation (BMT). There had been no obvious findings of graft versus host diseases (GVHD) after BMT, and the dosage of immunosuppressant drugs had not been reduced during this period. At the onset of MN, a few lymphoma cells still remained in the bone marrow; the patient achieved complete remission of MN after the disappearance of the lymphoma cells. In this case it is suggested that immune complexes including antigens expressed by lymphoma cells might induce MN. Therefore, this is a significant case that may reveal an alternative mechanism of the onset of MN related to BMT.
一名29岁的恶性淋巴瘤男性患者在异基因骨髓移植（BMT）后发生了膜性肾病（MN）。BMT后未出现明显的移植物抗宿主病（GVHD）表现，在此期间免疫抑制剂的剂量也未减少。MN发病时，骨髓中仍残留少量淋巴瘤细胞；淋巴瘤细胞消失后，患者的MN完全缓解。该病例提示，包括淋巴瘤细胞表达的抗原在内的免疫复合物可能诱发MN。因此，这是一个可能揭示与BMT相关的MN发病替代机制的重要病例。
