Pruzanski W, Platts M E
J Clin Invest. 1970 Sep;49(9):1694-708. doi: 10.1172/JCI106387.
Serum levels, urinary excretion, and clearances of several proteins of different molecular weights were studied in 18 patients with mono- and myelomonocytic leukemia. Nine patients had normal renal function (group A) and nine had impaired renal function with azotemia (group B). The majority of patients in both groups had increased concentration of immunoglobulins, particularly IgG, IgA, and IgM; IgD level was normal. Serum transferrin and alpha(2)-macroglobulin were frequently reduced while the level of ceruloplasmin was often increased, especially in patients with azotemia. The activity of lysozyme in the serum was high in all patients, but was considerably higher in group B. Proteinuria was found in most patients but was more prominent in group B. Almost invariably albumin constituted less than 25% of the total protein excreted. Qualitative analysis of various urinary proteins by immunochemical techniques and clearance studies suggested the presence of glomerular as well as tubular dysfunction. Determination of urinary lysozyme frequently showed no direct correlation between the serum level of the enzyme and its concentration in the urine or its clearance by the kidney. In addition to glomerular filtration, impaired tubular reabsorption may account for the high level of lysozyme in the urine. It is postulated that the very high level of lysozyme in the glomerular filtrate and possibly hypergammaglobulinemia may play a role in the induction of tubular damage. Renal impairment has been correlated with histological changes in the kidneys. From a comparative study of various leukemias, it seems that the combined glomerular-tubular dysfunction is a manifestation unique to mono- and myelomonocytic leukemia.
对18例单核细胞白血病和粒单核细胞白血病患者的几种不同分子量蛋白质的血清水平、尿排泄及清除率进行了研究。9例患者肾功能正常（A组），9例患者肾功能受损并伴有氮质血症（B组）。两组中的大多数患者免疫球蛋白浓度升高，尤其是IgG、IgA和IgM；IgD水平正常。血清转铁蛋白和α2-巨球蛋白经常降低，而铜蓝蛋白水平经常升高，尤其是在氮质血症患者中。所有患者血清溶菌酶活性均较高，但B组更高。大多数患者存在蛋白尿，但B组更明显。几乎在所有情况下，白蛋白占总排泄蛋白的比例均低于25%。通过免疫化学技术对各种尿蛋白进行定性分析及清除率研究表明存在肾小球及肾小管功能障碍。尿溶菌酶的测定经常显示该酶的血清水平与其在尿液中的浓度或肾脏对其的清除率之间无直接相关性。除肾小球滤过外，肾小管重吸收受损可能是尿液中溶菌酶水平高的原因。据推测，肾小球滤液中溶菌酶的极高水平以及可能的高丙种球蛋白血症可能在肾小管损伤的诱导中起作用。肾功能损害与肾脏的组织学变化相关。从对各种白血病的比较研究来看，似乎肾小球-肾小管联合功能障碍是单核细胞白血病和粒单核细胞白血病所特有的表现。
