ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2016, Vol. 25 ›› Issue (1): 94-98.DOI: 10.3969/cndt.j.issn.1006-298X.2016.01.021

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高血压、蛋白尿、肾脏病家族史

  

  • 出版日期:2016-02-26 发布日期:2016-02-04

Hypertension, proteinuria and a family history of kidney disease

  • Online:2016-02-26 Published:2016-02-04

摘要:

40岁男性患者,以眼睑水肿、高血压、蛋白尿起病,肾功能正常,血清载脂蛋白AI水平下降。患者父亲因“肾脏病”去世。肾活检肾组织刚果红染色阳性,皮肤脂肪组织及肠黏膜刚果红染色阴性。电镜下肾小球系膜区及内皮下大量异常物质沉积,肾小管间质及血管未受累。肾组织载脂蛋白A-Ⅰ(ApoA-Ⅰ)染色阳性,肾小球微分离质谱分析见高浓度ApoA-Ⅰ条带,基因检测结果显示ApoAⅠ基因c220A>G突变。该患者最终诊断为遗传性系统性载脂蛋白AⅠ淀粉样变性。

关键词: 遗传性系统性淀粉样变载脂蛋白A-I, 肾活检, 蛋白尿

Abstract:

A 40yearsold male patients who had a family history of kidney disease was admitted for hypertension, proteinuria and recurrent edema with normal renal function. Congo red staining was positive in his renal tissue but negative in skin, subcutaneous fat tissue and rectal mucosa. Those amyloid substances were deposited in mesangium and subendothelial area but absent in tubulointerstitial area and vessels. Further exploration for the precursor protein showed positive staining of ApoAⅠ and negative results for light chains, ApoB, ApoE, Lysozyme, transthyretin, and β2microglobulin. Sequencing of the apolipoprotein AⅠ gene revealed a mutation of c.220A>G. Finally he was diagnosed hereditary apolipoprotein A1 amyloidosis.