伴有慢性肾衰竭及硅胶乳房植入物的结晶轻链近端肾小管病：1例报告

Crystalline light chain proximal tubulopathy with chronic renal failure and silicone gel breast implants: 1 case report.

作者信息

Figueres Marie-Lucile, Beaume Julie, Vuiblet Vincent, Rabant Marion, Bassilios Nader, Herody Michel, Touchard Guy, Noël Laure-Hélène

机构信息

Laboratoire d'Anatomie Pathologique, Hôpital Necker, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, 75015, Paris, France.

Service de Néphrologie, Hôpital du Val de Grâce, 75005 Paris, France.

出版信息

Hum Pathol. 2015 Jan;46(1):165-8. doi: 10.1016/j.humpath.2014.10.008. Epub 2014 Oct 24.

DOI:10.1016/j.humpath.2014.10.008

PMID:25454480

Abstract

A 39-year-old female patient was admitted to explore chronic renal failure. Clinical history included silicone breast implants. Clinical examination was normal. Urinalysis revealed tubular proteinuria with Bence-Jones κ protein. Monoclonal immunoglobulin G κ and free monoclonal κ-light chains (LCs) were revealed by serum protein immunoelectrophoresis. Bone marrow aspiration with karyotype analysis and skeletal radiologic survey were normal. Kidney biopsy revealed a peculiar pattern of proximal tubular cells with hypertrophy and clarification initially diagnosed as an osmotic nephrosis. Immunofluorescence study, including immunoglobulin LCs conjugates was normal. Immunoelectron microscopy finally revealed a crystalline LC proximal tubulopathy κ. Our case presents some peculiarities: the absence of hematologic malignancy sign and the young patient's age. The silicone breast implants have been reported to be involved in the generation of monoclonal gammopathy.

摘要

一名39岁女性患者因慢性肾衰竭入院。临床病史包括硅胶隆胸。临床检查正常。尿液分析显示肾小管蛋白尿伴本-周κ蛋白。血清蛋白免疫电泳显示单克隆免疫球蛋白Gκ和游离单克隆κ轻链（LCs）。骨髓穿刺及核型分析和骨骼放射学检查均正常。肾活检显示近端肾小管细胞有特殊的肥大和清亮模式，最初诊断为渗透性肾病。包括免疫球蛋白轻链结合物的免疫荧光研究正常。免疫电子显微镜最终显示为结晶性轻链近端肾小管病κ。我们的病例有一些特殊之处：无血液系统恶性肿瘤迹象且患者年轻。据报道硅胶隆胸与单克隆丙种球蛋白病的发生有关。