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[骨髓增殖性肿瘤相关性肾小球病]

[The myeloproliferative neoplasms-related glomerulopathy].

作者信息

Bardy A, Tiple A, Rabant M, Kémény J-L, El Karoui K, Hermet M, Guettrot-Imbert G, Deteix P, Bay J-O, Aumaître O, André M

机构信息

Service de médecine interne, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.

Service de néphrologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.

出版信息

Rev Med Interne. 2014 Apr;35(4):222-30. doi: 10.1016/j.revmed.2013.04.014. Epub 2013 Jun 3.

Abstract

PURPOSE

Myeloproliferative neoplasms (MPN) are hematological disorders characterized by clonal expansion of one or more medullary lines. Renal complications are rare, chiefly as acute renal failure. Glomerular involvement is exceptional

METHODS

We report on a retrospective multicenter case series of eight patients who presented with a glomerulopathy (GP) associated with MPN RESULTS: All GP were revealed by a major proteinuria frequently associated with nephrotic syndrome and oedema. Histology was mainly characterized by lesions of focal segmental glomerulosclerosis associated with increased mesangial cellularity. The pathophysiology is still unclear but platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β), which play a central role in the MPN may be involved. A majority of patients developed chronic renal failure despite of a therapy intended to block the renin-angiotensin system

CONCLUSION

Monitoring of proteinuria during the follow-up of MPN would allow earlier diagnosis of renal involvement. Further studies on a larger scale are needed to specify the pathophysiological mechanisms involved and the management of these complications.

摘要

目的

骨髓增殖性肿瘤(MPN)是一种血液系统疾病,其特征为一个或多个髓系细胞系的克隆性增殖。肾脏并发症罕见,主要表现为急性肾衰竭。肾小球受累情况极为少见。

方法

我们报告了一项回顾性多中心病例系列研究,涉及8例患有与MPN相关的肾小球病(GP)的患者。

结果

所有GP均表现为重度蛋白尿,常伴有肾病综合征和水肿。组织学主要特征为局灶节段性肾小球硬化病变,伴有系膜细胞增多。其病理生理学仍不清楚,但在MPN中起核心作用的血小板衍生生长因子(PDGF)和转化生长因子-β(TGF-β)可能参与其中。尽管采用了旨在阻断肾素-血管紧张素系统的治疗方法,但大多数患者仍发展为慢性肾衰竭。

结论

在MPN随访期间监测蛋白尿有助于早期诊断肾脏受累情况。需要开展更大规模的进一步研究,以明确其中涉及的病理生理机制及这些并发症的管理方法。

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