Ravipati Prasanth, Bu Lihong, Sachs Zohar, Nachman Patrick H
Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE.
Department of Internal Medicine, Division of Nephrology and Hypertension, University of Minnesota Medical Center, Minneapolis, MN, USA.
Clin Nephrol Case Stud. 2022 Dec 15;10:87-90. doi: 10.5414/CNCS110756. eCollection 2022.
Kidney disease can be an initial presentation or a chronic manifestation of plasma cell dyscrasias. Here, we describe a rare presentation of kidney disease driven by lymphomatous infiltration of the kidney in a patient with Waldenstrom's macroglobulinemia (WM). A 70-year-old female with an 8-year history of WM (IgM, κ) was referred for declining renal function. Prior to presentation, she had stable WM disease without evidence of worsening disease burden. She had been previously hospitalized with SARS-CoV-2 infection and acute kidney injury (AKI). Her serum creatinine (sCr) peaked at 3.7 mg/dL (baseline 0.9 mg/dL) but recovered to 1.1 mg/dL by the time of discharge. Two months after discharge, her sCr increased to 1.9 mg/dL, and she had new proteinuria of 1.5 g/day. Kidney biopsy showed lymphomatous infiltration of the interstitium without glomerular involvement. Treatment with rituximab and bendamustine resulted in an improvement in renal function (sCr 1.4 mg/dL). WM is an uncommon hematologic malignancy, and extramedullary involvement, including renal involvement, is rare. This case emphasizes the importance of surveillance for kidney dysfunction in patients with plasma cell dyscrasias, even if patients appear to have stable lymphoproliferative disease.
肾脏疾病可能是浆细胞异常增殖性疾病的初始表现或慢性表现。在此，我们描述了1例由肾脏淋巴瘤浸润驱动的肾脏疾病的罕见表现，该患者患有华氏巨球蛋白血症（WM）。1名有8年华氏巨球蛋白血症（IgM，κ型）病史的70岁女性因肾功能下降前来就诊。就诊前，她的华氏巨球蛋白血症病情稳定，无疾病负担加重的证据。她曾因感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和急性肾损伤（AKI）住院。她的血清肌酐（sCr）峰值为3.7mg/dL（基线为0.9mg/dL），但出院时恢复至1.1mg/dL。出院后2个月，她的sCr升至1.9mg/dL，并且出现了1.5g/天的新蛋白尿。肾脏活检显示间质有淋巴瘤浸润，无肾小球受累。利妥昔单抗和苯达莫司汀治疗使肾功能得到改善（sCr为1.4mg/dL）。华氏巨球蛋白血症是一种罕见的血液系统恶性肿瘤，髓外受累（包括肾脏受累）很少见。该病例强调了对浆细胞异常增殖性疾病患者进行肾功能监测的重要性，即使患者的淋巴增殖性疾病似乎稳定。
