摘要
目的探讨特发性膜性肾病(IMN)合并新月体坏死性肾小球肾炎的诊断思路及肾病理与预后的关系。方法 5例IMN合并新月体坏死性肾小球肾炎经肾病理确诊,分析实验室指标和肾病理特点。结果 5例患者4例为男性,1例为女性,平均年龄65岁,均伴肾外症状,血清抗中性粒细胞胞浆抗体(ANCA)阳性,呈重度蛋白尿、低白蛋白血症和不同程度的肾功能减退。肾病理示5例均有不同程度的新月体形成和坏死病变;电镜显示1例为Ⅰ~Ⅱ期膜性肾病,3例为Ⅱ~Ⅲ期膜性肾病,1例为Ⅲ期膜性肾病。经免疫抑制治疗1例病情好转,其余4例无缓解。结论肾病理对于确诊具有重要意义,预后可能与新月体形成的程度和IMN的电镜分期相关,免疫抑制治疗仅对轻症患者有效。
Objective To analyze the characteristics of laboratory examination and renal pathology in senium idiopathic membranous nephropathy( IMN) patients associated with necrotizing and crescentic glomerulonephritis. To investigate the predictive features for diagnosis,therapeutic methods and prognosis of two combined diseases. Methods Laboratory and pathological findings in 5 senium patients with IMN and necrotizing and crescentic glomerulonephritis were analyzed. Results Five cases of IMN with necrotizing and crescentic glomerulonephritis included 4 males and 1 female with average age of 65 years old. All the cases manifested nephrotic syndrome,renal deficiency and renal external symptoms such as fever,rash,arthralgia,sinusitis,hemoptysis and pulmonary nodules. Laboratory data showed positive ANCA in the serum of 5 patients( four MPO-ANCA,one PR3-ANCA) and heavy proteinuria( mean 24 h urine protein 4. 78 g /24 h),hypoalbuminemia( mean serum albumin 23. 34 g /L),different degrees of hematuria and renal deficiency( mean serum creatinine 263. 06μmol/L). Renal pathological evaluation revealed 5 cases of IMN and necrotizing and crescentic glomerulonephritis with different degrees of crescents formation( involving a mean of 60. 8% of glomeruli) and necrosis( involving a mean of 12. 2% of glomeruli),thickening of the capillary wall and red subepithelial deposits. Upon electron microscopy,3 cases showed stage Ⅱ ~ Ⅲ membranous nephropathy and 1 case showed stage Ⅰ ~ Ⅱ and stage Ⅲ membranous nephropathy respectively. Among four patients treated with steroid plus cyclophosphamide,one displayed improvement of proteinuria and renal function,three showed no sign of improvement of proteinuria but exacerbation of renal function at a mean follow-up of 10 month. The one who received treatment of steroid alone also showed invalid. Conclusions IMN combined with necrotizing and crescentic glomerulonephritis is a rare glomerulopathy seen in senium patients with serious proteinuria,active urine sediment and acute renal failure. Th
出处
《中国老年学杂志》
CAS
CSCD
北大核心
2014年第18期5034-5036,共3页
Chinese Journal of Gerontology
基金
国家自然科学基金面上项目(No.81370810)
吉林省科技厅国际科技合作项目(No.20100738)
关键词
膜性肾病
新月体坏死性肾小球肾炎
抗中性粒细胞胞浆抗体
Membranous nephropathy
Necrotizing and crescentic glomerulonephritis
Anti-neutrophil cytoplasmic antibodies
