ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2011, Vol. 20 ›› Issue (6): 580-585.

• 论文 • 上一篇    

乏力,低钾,贫血伴肾功能不全

  

  • 出版日期:2011-12-28 发布日期:2011-12-20

  • Online:2011-12-28 Published:2011-12-20

摘要:

摘  要  49岁女性,临床上以乏力,低钾起病,近半年出现贫血,肾功能不全,无血尿,蛋白尿,无咯血等肺部表现,实验室检查提示以小管间质损害为主,血清核周型抗中性粒细胞胞质抗体(pANCA)阳性,弹性蛋白酶ANCA阳性。肾活检组织学表现为间质性肾炎,可见大量管周毛细血管炎,小管炎,伴肾小球废弃,非废弃肾小球病变轻微,免疫病理示寡免疫复合物沉积。经甲泼尼龙和环磷酰胺冲击治疗后,血清ANCA转阴,随之肾功能改善,重复肾活检肾小管间质急性病变也明显减轻。结合临床、实验室检查,对免疫抑制治疗反应及两次肾活检组织学特点,最终诊断为ANCA相关性间质肾炎。

Abstract:

ABSTRACT   A 49-year female was presented with fatigue, hypopotassemia, anemia, and renal dysfunction for half a year. The laboratary investigation showed tubulointerstitial injury without proteinuria and hemoturia. Serum pANCA and Elastase ANCA were positive. The renal histological examination demonstrated tubulointerstitial nephritis with peritubular capillaritis, tubulitis and some obsolescent, but otherwise near normal glomeruli. Immunoflurescence study indicated pauci-immune deposits. After immunosuppressive treatment, serum ANCA turned negative and renal function was remarkably improved. Repeat biopsy showed that the interstitial inflammation was significantly ameliorated. Finally, ANCA associated tubulointerstitial nephritis was diagnosed.

Key words: tubulointerstitial nephritis , anti-neutrophil cytoplasmic antibodies immunosuppressive treatment