Department of Pathology, University of Chicago Medical Center, IL 60637, USA.
Am J Kidney Dis. 2011 Jan;57(1):170-4. doi: 10.1053/j.ajkd.2010.08.011. Epub 2010 Oct 25.
We report a 69-year-old African American woman with hemoptysis and hematuria caused by a focally crescentic pauci-immune glomerular injury associated with the presence of antineutrophil cytoplasmic antibodies (ANCAs). An incidental diagnosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma also was established based on the kidney biopsy. Given that a subset of patients with CLL can develop autoantibodies to red blood cells, platelets, or, rarely, neutrophils, the simultaneous presence of CLL, ANCA, and a pauci-immune crescentic glomerulonephritis may not be a coincidence. Recent advances in the pathogenic role of ANCAs in pauci-immune crescentic glomerulonephritis may link the underlying CLL to this patient's glomerular injury. Awareness of this possible association may be important for clinicians who manage patients with CLL, as well as for renal pathologists who diagnose pauci-immune crescentic glomerulonephritis.
我们报告了一例 69 岁的非裔美国女性，因局灶性新月体形成性少免疫性肾小球损伤伴有抗中性粒细胞胞质抗体（ANCA）而出现咯血和血尿。基于肾脏活检还意外诊断出慢性淋巴细胞白血病（CLL）/小淋巴细胞淋巴瘤。鉴于一小部分 CLL 患者可能会产生针对红细胞、血小板或罕见中性粒细胞的自身抗体，因此 CLL、ANCA 和少免疫性新月体肾小球肾炎的同时存在可能并非巧合。最近在 ANCAs 在少免疫性新月体肾小球肾炎中的致病作用方面的进展可能将潜在的 CLL 与该患者的肾小球损伤联系起来。了解这种可能的关联对于治疗 CLL 患者的临床医生以及诊断少免疫性新月体肾小球肾炎的肾脏病理学家可能很重要。
