Besso Luca, Quercia Alessandro Domenico, Daidola Germana, Burdese Manuel, Colla Loredana, Basso Elisa, Karvela Eirini, Marcuccio Cristina, Tarella Corrado, Segoloni Giuseppe Paolo
SC Nefrologia-Dialisi-Trapianto, AOU ''S. Giovanni Battista'', Torino, Italy.
G Ital Nefrol. 2010 Sep-Oct;27 Suppl 50:S34-9.
The incidence of lymphomas, especially non-Hodgkin's lymphoma (NHL), has shown a steady increase over the last decades. At the same time, the prognosis has improved. Given the longer survival of lymphoma patients, pathological manifestations related to malignancy might become more frequent. In this setting, the kidney is one of the most important solid organs affected by direct or indirect lymphomatous involvement. Kidney involvement can be related to obstruction or treatment-induced toxicity, but more intriguing are 1) direct infiltration (NHL); 2) renal malignancies in patients affected by Hodgkin's disease or NHL; 3) associated glomerular diseases. Primary infiltration is rarely seen, while secondary infiltration is described most frequently in autopsy series, even in the absence of renal failure. These alterations may mimic glomerular and/or interstitial disease. The association with kidney malignancies, mostly renal cell carcinoma but also urothelial tumors in Hodgkin''s disease, is higher in lymphoma patients than in the general population: the relative risk at 10 years is about 1.5. Glomerulonephritis is described in patients with Hodgkin's disease or NHL; in the former minimal change disease is most frequent, in the latter the glomerular pattern varies widely. Glomerulonephritis can precede, be concurrent with, or follow lymphoma manifestations. Renal biopsy is often needed in this setting.
在过去几十年中，淋巴瘤尤其是非霍奇金淋巴瘤（NHL）的发病率呈稳步上升趋势。与此同时，其预后有所改善。鉴于淋巴瘤患者的生存期延长，与恶性肿瘤相关的病理表现可能会更加频繁。在这种情况下，肾脏是受直接或间接淋巴瘤累及的最重要实体器官之一。肾脏受累可能与梗阻或治疗引起的毒性有关，但更引人关注的是：1）直接浸润（NHL）；2）霍奇金病或NHL患者发生的肾脏恶性肿瘤；3）相关的肾小球疾病。原发性浸润很少见，而继发性浸润在尸检系列中描述最为频繁，即使在没有肾衰竭的情况下也是如此。这些改变可能类似肾小球和/或间质性疾病。淋巴瘤患者发生肾脏恶性肿瘤的几率高于普通人群，主要是肾细胞癌，霍奇金病中也有尿路上皮肿瘤：1０年时的相对风险约为1.5。霍奇金病或NHL患者中可出现肾小球肾炎；在前者中，微小病变病最为常见，在后者中，肾小球模式差异很大。肾小球肾炎可先于、并发或继发于淋巴瘤表现。在这种情况下通常需要进行肾活检。
