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放射性肾病合并以淋巴细胞和浆细胞浸润为主的肾小管间质性肾炎。

Radiation Nephropathy Complicated by Tubulointerstitial Nephritis with Predominantly Lymphocyte and Plasma Cell Infiltration.

作者信息

Kosaka Tatsuaki, Takaori Koji, Izumiya Azusa, Hirai Daisuke, Koizumi Mitsuteru, Yamamoto Shinya, Mii Akiko, Shimizu Akira, Nakamura Kiyonao, Araki Norio, Seta Koichi

机构信息

Departments of Nephrology, National Hospital Organization Kyoto Medical Center, Japan.

Department of Nephrology, Kyoto University Graduate School of Medicine, Japan.

出版信息

Intern Med. 2025 Jun 1;64(11):1696-1705. doi: 10.2169/internalmedicine.4265-24. Epub 2024 Nov 1.

DOI:10.2169/internalmedicine.4265-24
PMID:39496448
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12222972/
Abstract

A 64-year-old Japanese woman presented with gross hematuria and was diagnosed with stage IVB cervical cancer. Renal dysfunction was observed following chemoradiation therapy, and a renal biopsy revealed renal thrombotic microangiopathy (TMA) and tubulointerstitial nephritis (TIN), which are atypical features of radiation nephropathy. Contrast-enhanced computed tomography revealed wedge-shaped areas of high contrast, consistent with areas of high radiation dose in the kidneys, thus leading to the diagnosis of radiation nephropathy. This case underscores the importance of integrating clinical, pathological, and radiological findings for the diagnosis of radiation nephropathy, atypical renal biopsy findings, and a combination of TIN and renal TMA.

摘要

一名64岁的日本女性因肉眼血尿就诊，被诊断为IVB期宫颈癌。放化疗后出现肾功能障碍，肾活检显示为肾血栓性微血管病（TMA）和肾小管间质性肾炎（TIN），这些都是放射性肾病的非典型特征。增强计算机断层扫描显示楔形高对比度区域，与肾脏高辐射剂量区域一致，从而确诊为放射性肾病。该病例强调了综合临床、病理和影像学检查结果对诊断放射性肾病、非典型肾活检结果以及TIN和肾TMA合并症的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/a1da0754dc0c/1349-7235-64-11-1696-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/8fab143c7559/1349-7235-64-11-1696-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/4467a1e908a2/1349-7235-64-11-1696-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/d2f5bffb8981/1349-7235-64-11-1696-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/ce4b11d68f2c/1349-7235-64-11-1696-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/3e3b04672bfe/1349-7235-64-11-1696-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/a1da0754dc0c/1349-7235-64-11-1696-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/8fab143c7559/1349-7235-64-11-1696-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/4467a1e908a2/1349-7235-64-11-1696-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/d2f5bffb8981/1349-7235-64-11-1696-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/ce4b11d68f2c/1349-7235-64-11-1696-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/3e3b04672bfe/1349-7235-64-11-1696-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/166c/12222972/a1da0754dc0c/1349-7235-64-11-1696-g006.jpg

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本文引用的文献

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JCI Insight. 2023 Apr 24;8(8):e166643. doi: 10.1172/jci.insight.166643.
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Radiation-induced kidney toxicity: molecular and cellular pathogenesis.辐射诱导的肾毒性：分子和细胞发病机制。
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Infliximab-Induced Tubulointerstitial Nephritis with Image Findings of Striated Nephrogram in Crohn's Disease.
英夫利昔单抗诱导的肾小管间质性肾炎伴克罗恩病中条纹状肾图的影像学表现
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