Clonal monocytosis reflects a preneoplastic or neoplastic sustained increase in the absolute monocyte count in the absence of reactive causes. Causes of clonal monocytosis include clonal cytopenias with monocytosis and acute and chronic myeloid neoplasms. Chronic myelomonocytic leukemia is a prototypical myelodysplastic/myeloproliferative overlap neoplasm in adults, characterized by sustained peripheral blood monocytosis. Kidney abnormalities, including acute kidney injury and chronic kidney disease, are frequent in patients with chronic myelomonocytic leukemia and are predictors of worse outcomes. In addition, acute kidney injury/chronic kidney disease often limits eligibility for allogeneic stem cell transplantation or enrollment in clinical trials. In this review, we highlight clonal monocytosis–related etiologies that give rise to acute kidney injury and chronic kidney disease, with special emphasis on chronic myelomonocytic leukemia and lysozyme-induced nephropathy. Monocytes produce lysozyme, which, in excess, can accumulate in and damage the proximal renal tubular epithelium. Early identification of this etiology and a timely reduction in monocyte counts can salvage kidney function. Other etiologies of kidney injury associated with clonal monocytosis include direct renal infiltration by monocytes, renal extramedullary hematopoiesis, myeloproliferative neoplasm–associated glomerulopathy, autoimmune (membranous nephropathy, minimal change disease) and paraneoplastic manifestations, thrombotic microangiopathy, obstructive nephropathy due to myeloproliferation, and urate nephropathy due to tumor lysis syndrome. We propose to group these mechanistic etiologies of kidney injury as clonal monocytosis of renal significance and provide guidance on their diagnosis and management.

中文翻译：

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具有肾脏意义的克隆性单核细胞增多症


克隆性单核细胞增多症反映了在没有反应性原因的情况下，绝对单核细胞计数的前体或肿瘤性持续增加。克隆性单核细胞增多症的病因包括克隆性血细胞减少伴单核细胞增多症以及急性和慢性髓系肿瘤。慢性粒单核细胞白血病是成人典型骨髓增生异常/骨髓增生性重叠肿瘤，其特征是持续的外周血单核细胞增多症。肾脏异常，包括急性肾损伤和慢性肾病，在慢性粒单核细胞白血病患者中很常见，并且是预后较差的预测指标。此外，急性肾损伤/慢性肾病通常会限制同种异体干细胞移植或参加临床试验的资格。在本综述中，我们重点介绍了导致急性肾损伤和慢性肾病的克隆性单核细胞增多症相关病因，特别强调慢性粒单核细胞白血病和溶菌酶诱导的肾病。单核细胞产生溶菌酶，溶菌酶过量时可在近端肾小管上皮中积累并损伤。早期识别这种病因并及时减少单核细胞计数可以挽救肾功能。与克隆性单核细胞增多症相关的肾损伤的其他病因包括单核细胞直接浸润肾脏、肾髓外造血、骨髓增生性肿瘤相关肾小球病、自身免疫性（膜性肾病、微小病变肾病）和副肿瘤表现、血栓性微血管病、骨髓增生引起的梗阻性肾病和肿瘤溶解综合征引起的尿酸盐肾病。 我们建议将这些肾损伤的机制病因归类为具有肾脏意义的克隆性单核细胞增多症，并为其诊断和管理提供指导。