Department of Pathology, University of Washington Medical Center, Seattle, WA, USA.
Am J Kidney Dis. 2011 Nov;58(5):855-9. doi: 10.1053/j.ajkd.2011.07.011. Epub 2011 Sep 10.
We report a case of collapsing glomerulopathy associated with natural killer cell leukemia in a previously healthy 27-year-old African American man. An initial kidney biopsy showed findings concordant with the cellular variant of focal segmental glomerulosclerosis. A repeated biopsy 3 months later showed collapsing glomerulopathy, likely representing a morphologic evolution from a cellular variant into the collapsing glomerulopathy variant of focal segmental glomerulosclerosis. Collapsing glomerulopathy has been described in connection with a number of disparate disorders in which podocyte injury seems to be the common denominator. The close temporal association between clinical presentation and the development of nephropathy provides support for a direct pathogenic link between the underlying lymphoproliferative disorder and the glomerular lesions. We hypothesize that dysregulated cytokine production by the neoplastic cells led to podocyte alterations and eventually to the development of collapsing glomerulopathy.
我们报告了一例与自然杀伤细胞白血病相关的伴塌陷性肾小球病的病例，患者为一名既往健康的 27 岁非裔美国男性。初次肾活检显示符合局灶节段性肾小球硬化细胞型的表现。3 个月后的重复肾活检显示伴塌陷性肾小球病，可能代表了从细胞型向局灶节段性肾小球硬化塌陷型的形态学演变。塌陷性肾小球病已在许多不同的疾病中被描述，其中足细胞损伤似乎是共同的发病机制。临床表现与肾病的发生之间的密切时间关联为潜在的淋巴增生性疾病与肾小球病变之间存在直接的致病联系提供了支持。我们假设，肿瘤细胞中细胞因子的失调产生导致了足细胞的改变，并最终导致了塌陷性肾小球病的发生。
