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继发于小淋巴细胞淋巴瘤的伴轻链限制性沉积膜性肾病1例报告

Membranous nephropathy with light chain-restricted deposition secondary to small lymphocytic lymphoma: a case report

  • 摘要: 患者男性,56岁,因“尿检异常1个月余”入院。血清游离轻链κ/λ比值升高,免疫固定电泳可见IgG-κ型单克隆免疫球蛋白条带。肾组织病理检查示肾小球膜性病变,电镜下见基膜上皮侧及系膜区有电子致密物沉积,免疫荧光示肾小球IgG1/IgG3-κ沉积。结合患者临床表现、骨髓流式细胞学检查及淋巴结病理结果,诊断为小淋巴细胞淋巴瘤(small lymphocytic lymphoma, SLL),以及继发于SLL的伴轻链限制性沉积(IgG1/IgG3-κ)的膜性肾病。患者接受奥妥珠单抗治疗后蛋白尿部分缓解,淋巴结显著缩小,达到临床缓解。

     

    Abstract: The patient was a 56-year-old man who presented with abnormal urinalysis findings of over one month’s duration. Serological tests revealed an elevated serum free light chain κ/λ ratio, and immunofixation electrophoresis detected an IgG-κ monoclonal band. Renal biopsy demonstrated membranous nephropathy, with electron-dense deposits observed in the subepithelial space and mesangium on electron microscopy. Immunofluorescence confirmed glomerular deposits of IgG1/IgG3-κ. Based on clinical manifestation, bone marrow flow cytology, and lymph node pathology, the patient was diagnosed with small lymphocytic lymphoma (SLL), and membranous nephropathy with light chain-restricted deposition (IgG1/IgG3-κ) secondary to SLL. After receiving obinutuzumab treatment, the patient’s proteinuria partially remitted, the lymph nodes significantly shrank, and clinical remission was achieved.

     

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