红细胞管型堵塞致急性肾衰竭IgA肾病1例报告并文献复习
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摘要
目的探讨IgA肾病时肾衰竭的罕见原因。方法回顾分析1例IgA肾病肾衰竭患儿的临床资料。结果男性患儿,6岁,入院前3个月内反复发作性肉眼血尿3次,均有呼吸道感染诱因,不伴明显蛋白尿。前2次经抗感染、对症处后约1周内尿色转清。第3次肉眼血尿发作1天后出现少尿、急性肾衰竭,经血液滤过、抗感染、对症、支持治疗后完善肾活检,病理示轻-中度系膜增生性Ig A肾病(M1E1S0T0),伴急性肾小管损伤(肾小管多量红细胞管型)。进一步给予抗感染、利尿、碱化尿液等对症、支持治疗,患儿肌酐逐渐下降,病程近4周时恢复正常。结论 IgA肾病时肉眼血尿导致急性肾衰竭较为少见,其主要机制为红细胞管型造成肾小管的机械堵塞。
Objective To explore the rare cause of renal failure in childhood IgA nephropathy. Methods A six year-old boy presented with recurrent gross hematuria for 3 months and increased serum creatinine for 5 days, blood and urine routine test, renal function, urinary protein concentration and renal biopsy were performed for diagnosis. Results The boy had three episodes of recurrent gross hematuria with a predisposed respiratory tract infection, he recovered within a week after antibiotic therapy from previous two episodes, but oliguria and renal failure were occurred in the third episode. Renal biopsy showed Ig A nephropathy with presence of red blood cell casts in as much as 50% of the tubular lumen and acute tubular lesion. His renal function recovered gradually to normal within 4 weeks after treatment with anti-infection, diuresis and alkalization of urine. Conclusions This article reported the renal failure case induced by tubular damage and obstruction by red blood cell casts in childhood Ig A nephropathy.
Objective To explore the rare cause of renal failure in childhood IgA nephropathy. Methods A six year-old boy presented with recurrent gross hematuria for 3 months and increased serum creatinine for 5 days, blood and urine routine test, renal function, urinary protein concentration and renal biopsy were performed for diagnosis. Results The boy had three episodes of recurrent gross hematuria with a predisposed respiratory tract infection, he recovered within a week after antibiotic therapy from previous two episodes, but oliguria and renal failure were occurred in the third episode. Renal biopsy showed Ig A nephropathy with presence of red blood cell casts in as much as 50% of the tubular lumen and acute tubular lesion. His renal function recovered gradually to normal within 4 weeks after treatment with anti-infection, diuresis and alkalization of urine. Conclusions This article reported the renal failure case induced by tubular damage and obstruction by red blood cell casts in childhood Ig A nephropathy.
引文
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[13]Moreno JA,Martin-Cleary C,Gutierrez E,et al.AKI associated with macroscopic glomerular hematuria:clinical and pathophysiologic consequences[J].Clin J Am Soc Nephrol,2012,7(1):175-184.
[14]August C,Atzeni A,Koster L,et al.Acute renal failure in Ig A nephropathy:aggravation by gross hematuria due to anticoagulant treatment[J].J Nephrol,2002,15(6):709-712.
[15]Brodsky SV,Satoskar A,Chen J,et al.Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts:a report of 9 cases[J].Am J Kidney Dis,2009,54(6):1121-1126.
[2]Diciolla M,Binetti G,Di Noia T,et al.Patient classification and outcome prediction in Ig A nephropathy[J].Comput Biol Med,2015,66:278-286.
[3]Floege J.Prognostic assessment of Ig A nephropathy:how much does histology add?[J].Kidney Int,2016,89(1):19-21.
[4]Ai Z,Xu R,Liu W,et al.Clinicopathologic features of Ig A nephropathy patients with different levels of proteinuria[J].Clin Nephrol,2016,86(7):35-41.
[5]Fellin G,Gentile MG,Duca G,et al.Renal function in Ig A nephropathy with established renal failure[J].Nephrol Dial Transplant,1988,3(1):17-23.
[6]Bennett WM,Kincaid-Smith P.Macroscopic hematuria in mesangial Ig A nephropathy:correlation with glomerular crescents and renal dysfunction[J].Kidney Int,1983,23(2):393-400.
[7]Praga M,Gutierrez-Millet V,Navas JJ,et al.Acute worsening of renal function during episodes of macroscopic hematuria in Ig A nephropathy[J].Kidney Int,1985,28(1):69-74.
[8]Delclaux C,Jacquot C,Callard P,et al.Acute reversible renal failure with macroscopic haematuria in Ig A nephropathy[J].Nephrol Dial Transplant,1993,8(3):195-199.
[9]Kobayashi Y,Omori S,Kamimaki I,et al.Acute reversible renal failure with macroscopic hematuria in HenochSchonlein purpura[J].Pediatr Nephrol,2001,16(9):742-744.
[10]Wen YK.Comparison of prominent glomerular injury and prominent tubular injury in immunoglobulin A nephropathy[J].Int Urol Nephrol,2010,42(3):753-758.
[11]Kveder R,Lindic J,Ales A,et al.Acute kidney injury in immunoglobulin A nephropathy:potential role of macroscopic hematuria and acute tubulointerstitial injury[J].Ther Apher Dial,2009,13(4):273-277.
[12]燕宇,董葆,王梅.Ig A肾病并发肉眼血尿相关急性肾损伤临床及病理分析[J].中国实用内科杂志,2010,30(3):230-231.
[13]Moreno JA,Martin-Cleary C,Gutierrez E,et al.AKI associated with macroscopic glomerular hematuria:clinical and pathophysiologic consequences[J].Clin J Am Soc Nephrol,2012,7(1):175-184.
[14]August C,Atzeni A,Koster L,et al.Acute renal failure in Ig A nephropathy:aggravation by gross hematuria due to anticoagulant treatment[J].J Nephrol,2002,15(6):709-712.
[15]Brodsky SV,Satoskar A,Chen J,et al.Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts:a report of 9 cases[J].Am J Kidney Dis,2009,54(6):1121-1126.