Miwa Masashi, Sakao Yukitoshi, Ishigaki Sayaka, Ono Masafumi, Fujikura Tomoyuki, Yasuda Hideo, Suzuki Hiroyuki, Kato Akihiko, Nagata Yasuyuki, Shigeno Kazuyuki, Nakamura Satoki, Ohnishi Kazunori, Fujigaki Yoshihide
Internal Medicine I, Division of Nephrology, Hamamatsu University School of Medicine, Japan.
Intern Med. 2012;51(13):1725-30. doi: 10.2169/internalmedicine.51.7207. Epub 2012 Jul 1.
A 60-year-old man with Waldenström's macroglobulinemia (WM) was admitted to our hospital for evaluation of rapid progressive renal deterioration despite 3 cycles of oral melphalan and prednisolone (MP) therapy. Renal biopsy just before introducing hemodialysis revealed cast nephropathy and severe tubulo-interstitial infiltration of B lymphocytes. After 6 cycles of rituximab, cyclophosphamide, vincristine and prednisolone (R-COP) therapy, his renal function improved enough to discontinue hemodialysis. This is a rare case of WM-related renal involvement caused by both monoclonal protein and tumor infiltration and, to our knowledge, the second report on improved renal function by rituximab-based therapy.
一名60岁的华氏巨球蛋白血症（WM）男性患者因尽管接受了3个周期的口服美法仑和泼尼松（MP）治疗，但仍出现快速进行性肾功能恶化而入院。在开始血液透析前进行的肾活检显示有管型肾病以及B淋巴细胞严重的肾小管间质浸润。在接受6个周期的利妥昔单抗、环磷酰胺、长春新碱和泼尼松（R-COP）治疗后，他的肾功能改善到足以停止血液透析。这是一例由单克隆蛋白和肿瘤浸润共同导致的罕见的WM相关性肾受累病例，据我们所知，这是关于基于利妥昔单抗的治疗使肾功能改善的第二篇报道。
