一波三折的非霍奇金淋巴瘤相关肾损害

Twists and turns of non-Hodgkin's lymphoma-associated renal damage

目的分享并探讨诊断困难的非霍奇金淋巴瘤相关肾损害的诊疗经验。方法分享广州中医药大学第二附属医院2019年12月收治的1例非霍奇金淋巴瘤相关肾损害病人的诊疗经过和诊断过程。结果第1阶段,病人表现为肾病综合征,于外院行肾穿刺活检诊断为膜性肾病Ⅰ期、冷球蛋白血症肾损害待排。第2阶段,病人因急性肾损伤入住广州中医药大学第二附属医院,行肾穿刺活检诊断为膜性肾病Ⅱ期伴新月体肾小球肾炎。第3阶段,病人因左眼眶肿物,行活检后诊断为非霍奇金淋巴瘤。第4阶段,病人因腹膜炎入院,后病情缓解,摆脱血液透析和腹膜透析。随着化疗肿瘤及肾病的缓解,考虑非霍奇金淋巴瘤相关肾损害成立。结论最初诊断膜性肾病的中老年病人,需更频繁地进行恶性肿瘤筛查。

Objective To share and discuss the diagnosis and treatment experience of non-Hodgkin's lymphoma-related renal damage with diagnostic difficulties.Methods The diagnosis and treatment experience and diagnostic process were shared of a patient with non-Hodgkin's lymphoma-related renal damage admitted to the The Second Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2019.Results In the first stage,the patient presented with nephrotic syndrome and was diagnosed with membranous nephropathy stageⅠand cryoglobulinemia renal damage to be drained by renal puncture biopsy in another hospital.In the second stage,the patient was admitted to The Second Affiliated Hospital of Guangzhou University of Chinese Medicine for acute kidney injury,underwent renal puncture biopsy and was diagnosed with membranous nephropathy stageⅡwith crescentic glomerulonephritis.In the third stage,the patient was diagnosed with non-Hodgkin's lymphoma after performing biopsy for left orbital swelling.In the fourth stage,the patient was admitted to hospital because of peritonitis,and then his condition was relieved,and he got rid of hemodialysis and peritoneal dialysis.The remission of tumor and the renal disease with chemotherapy suggested a diagnosis of non-Hodgkin's lymphoma related renal damage.Conclusion Middle-aged and elderly patients initially diagnosed with membranous nephropathy need to be screened more frequently for malignancy.