De Sanctis Lucia Barbara, Sestigiani Elena, Sgarlato Veronica, Fabbrizio Benedetta, Santoro Antonio
U.O. Nefrologia, Dialisi Ipertensione, Azienda Ospedaliera-Universitaria ''S. Orsola-Malpighi'', Bologna, Italy.
G Ital Nefrol. 2010 Sep-Oct;27 Suppl 50:S19-33.
Lymphoproliferative disorders often involve the kidney either by direct cell infiltration (lymphoma) or by deposition of paraproteins (monoclonal gammopathy, multiple myeloma, LCDD, amyloidosis). Nowadays the latter phenomenon seems to be the most common as a result of the growing number of elderly people affected by monoclonal gammopathies. The nephrotoxic potential of monoclonal immunoglobulins and amyloidogenic proteins make monoclonal gammopathies clinical entities of considerable interest in nephrology. Renal involvement presents different clinicomorphological patterns depending on the qualitative and quantitative characteristics of the paraproteins. Tubulointerstitial toxicity is frequent, while vascular and glomerular lesions resulting from non-inflammatory reactions due to immunoglobulin deposition are less common. Acute kidney failure may complicate the clinical course; this could be due to tubular obstruction by paraproteins or to hypovolemia induced by chemotherapy in association with diuretics. Early diagnosis of renal involvement will allow prophylactic interventions to prevent renal complications. At the same time, the increased number of therapeutic tools has enabled better management of kidney complications in lymphoproliferative disorders.
淋巴增生性疾病常累及肾脏，其途径要么是通过直接细胞浸润（淋巴瘤），要么是通过副蛋白沉积（单克隆丙种球蛋白病、多发性骨髓瘤、轻链沉积病、淀粉样变性）。如今，由于受单克隆丙种球蛋白病影响的老年人数量不断增加，后一种现象似乎最为常见。单克隆免疫球蛋白和淀粉样蛋白生成蛋白的肾毒性潜力使单克隆丙种球蛋白病成为肾脏病学中相当受关注的临床实体。根据副蛋白的定性和定量特征，肾脏受累呈现不同的临床形态学模式。肾小管间质毒性很常见，而由免疫球蛋白沉积引起的非炎症反应导致的血管和肾小球病变则较少见。急性肾衰竭可能使临床病程复杂化；这可能是由于副蛋白导致肾小管梗阻，或者是化疗联合利尿剂引起的血容量不足。肾脏受累的早期诊断将有助于采取预防性干预措施以预防肾脏并发症。与此同时，治疗手段的增加使得能够更好地管理淋巴增生性疾病中的肾脏并发症。
