Close Modal


Currently filtering by tag: Chronic myelomonocytic leukemia

Art of Medicine: Lysozyme Nephropathy

The painting above shows acute tubular injury with numerous intracytoplasmic inclusions within proximal tubular epithelium, which can be seen in lysozyme-associated nephropathy.  Lysozyme-induced nephropathy is a rare cause of acute tubular injury seen in patients with hematologic malignancies, most commonly with chronic myelomonocytic leukemia (CMML) and acute monocytic leukemia (Santoriello et al, 2017).   Malignancy associated overproduction of lysozyme can lead to acute kidney injury and proteinuria.  Lysozyme is freely filtered by the glomerulus and reabsorbed by the proximal tubular epithelium.  While this happens at a low level physiologically, over-reabsorption of lysozyme induces toxic acute tubular injury. Lysozyme-induced nephropathy is one...


A 76-year-old Caucasian male with renal failure underwent renal biopsy. He had a serum creatinine of 2.1 mg/dl and a urine protein/creatinine ratio of 0.3.  SPEP showed hypergammaglobulinemia with a polyclonal increase, no monoclonal proteins were identified.  The patient has a past medical history of Chronic myelomonocytic leukemia (CMML). Despite the lack of significant proteinuria, the renal biopsy is characterized by proximal tubules that are stuffed with numerous brightly eosinophilic and silver negative protein resorption droplets (A). The droplets are weakly PAS-positive and strongly positive for lysozyme (B and C). These findings are consistent with lysozyme nephropathy. This is a...