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- OpenAccess
Chronic Lymphocytic Leukemia in a Case with Chronic Renal Failure
慢性淋巴球白血病與腎衰竭
摘要
罹患慢性淋巴球白血病的病人，在疾病的過程中若產生急性腎衰竭的情形，通常會被歸因於尿道阻塞、腫瘤溶解症候群、感染、腎絲球腎炎或因使用具有腎毒性的藥物等所造成，而腎臟本身被淋巴球浸潤現象則較不被認為是造成腎功能惡化的原因。在文獻報告中，化學治療曾經使罹患慢性淋巴球白血病且併發急性腎衰竭的病人回復或改善其腎功能，但是尚未有慢性腎衰竭的慢性淋巴球白血病病人因化學治療而改善腎功能的報告。本篇文章提供一位慢性腎衰竭的病患合併罹患慢性淋巴球白血病，腎臟切片顯示有淋巴球浸潤現象，而間歇性化學治療則可以使其快速惡化的腎功能改善並維持穩定。因此建議罹患慢性淋巴球白血病的病人若其腎功能急速惡化，除了上述可能的原因外，淋巴球浸潤腎臟組織亦應列入考慮，不論其是否原先即已有慢性腎衰竭的情形，若無明顯原因可解釋其腎功能惡化，應實施腎臟切片以排除腎臟被淋巴球浸潤的可能。
並列摘要
Renal failure developed following chronic lymphocytic leukemia (CLL) is usually the result of complications such as obstruction, tumor lysis, infection, hemolysis, glomerulonephritis, cryoglobulinemia, lightchain disease or nephrotoxic effect of medication. There has not been any report on the effect of chemotherapy in improvement of renal function in the case of chronic renal insufficiency with CLL. In this case, intermittent chemotherapy is beneficial to the regression and maintenance of renal function. It is suggested that renal infiltration of lymphoid cells must be taken into differential diagnosis in patients with CLL who suffer from renal dysfunction, even in case of underlying impaired renal function with small kidneys. If no definite cause of renal dysfunction can be identified, renal biopsy should be performed to rule out infiltration of lymphocytic cells.
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