Radiation nephritis following total-body irradiation and cyclophosphamide in preparation for bone marrow transplantation.
Radiation nephritis following total-body irradiation and cyclophosphamide in preparation for bone marrow transplantation.
复制标题
全身照射和环磷酰胺后的放射性肾炎，为骨髓移植做准备。
作者：
J. Bergstein;Sharon P. Andreoli;A J Provisor;Moonahm Yum
两名准备接受全身照射和环磷酰胺骨髓移植的儿童在移植后6个月出现高血压、镜下血尿、蛋白尿、肾功能下降和贫血。肾脏的光学显微镜检查显示系膜扩张、肾小球毛细血管壁增厚和管腔血栓形成。电子显微镜显示由于无定形蓬松物质的沉积，内皮下空间变宽。在一个病人，免疫荧光显微镜显示肾小球毛细血管壁沉积纤维蛋白和免疫球蛋白。临床及组织学检查结果支持放射性肾炎的诊断。准备接受全身照射和环磷酰胺骨髓移植的患者，移植后应密切随访高血压、蛋白尿和肾功能不全的发生情况。
Two children prepared for bone marrow transplantation with total-body irradiation and cyclophosphamide developed hypertension, microscopic hematuria, proteinuria, diminished renal function, and anemia six months after transplantation. Light microscopy of the kidneys revealed mesangial expansion, glomerular capillary wall thickening, and lumenal thrombosis. Electron microscopy demonstrated widening of the subendothelial space due to the deposition of amorphous fluffy material. In one patient, immunofluorescence microscopy revealed glomerular capillary wall deposition of fibrin and immunoglobulins. The clinical and histologic findings support the diagnosis of radiation nephritis. Patients prepared for bone marrow transplantation with total-body irradiation and cyclophosphamide should be followed closely after transplantation for the development of hypertension, proteinuria, and renal insufficiency.