以肾衰竭为首发表现的Castleman病一例并文献复习

Castleman Disease With Renal Failure as an Initial Symptom:a Case Report and Literature Review

目的探讨以肾衰竭为首发表现的Castleman病的临床表现及病理特点。方法对收治的以肾衰竭为首发表现的Castleman病1例的临床资料进行回顾性分析。结果患者因水肿及尿色异常10个月,肾功能异常4个月就诊。曾在外院诊断为慢性肾功能不全(尿毒症期),予腹膜透析及相关治疗后病情未见明显缓解。入院后经骨髓穿刺细胞学检查、淋巴结活组织病理检查(活检)、免疫组织化学染色及肾脏组织病理检查诊断为多中心浆细胞型Castleman病、慢性肾脏病Ⅳ期,予化疗及对症治疗后病情好转出院。随访8年余,病情未复发。结论对急性肾功能损害者应积极寻找病因,伴淋巴结增大者要考虑到Castleman病的可能,及时行淋巴结活检,减少误诊误治。

Objective To discuss clinical and pathological characteristics of Castleman disease with renal failure as an initial symptom. Methods Clinical data of one Castleman disease patient with renal failure as an initial symptom was ret- rospectively analyzed. Results The patient went to hospital because of edema and abnormal urine colour for 10 months and abnormal renal function for 4 months. The patient was diagnosed as having chronic kidney insufficiency （uremia period） , and the symptom did not relieve after peritoneal dialysis and other related treatments. Multicentric Castleman disease and chronic kidney disease （ stage 1V ） was confirmed by results of bone marrow biopsy cytological examination, lymph node biopsy patho- logic examination, immunohistochemical staining and pathologic examination for kidney tissue after admission. Chemotherapy and symptomatic treatment were given, and the patient was discharged after condition had improved. With follow-up for more than 8 years, the patient had no recurrence. Conclusion Clinicians should actively find causes of patients with acute kidney injury, and consider the possibility of Castleman disease when patients have multiple lymph nodes enlargement. Lymph node biopsy should be performed early to avoid misdiagnosis and mistreatment.