Fernández de Monter C J, Fargier B, Villaquirán A
Unidad de Nefrología, Diálisis y Trasplante Renal, Universidad de los Andes, Hospital Universitario de los Andes, Mérida, Venezuela.
Nefrologia. 2000 Mar-Apr;20(2):151-7.
This is a study of a group of 23 patients from 16 families with a shared family tree, developing chronic renal insufficiency (CRI). Out of the 23 patients, 18 were female and five male with an average renal death age of 18.4 years old, showing fevo clinical manifestations. The main reason for consultation was the significant level of anemia. 17 patients had normal arterial tension, 1 patient manifested severe artery hypertension (AHT), 3 manifested mild AHT, and 2 manifested slight AHT. All the patients entered the final stage of CRI with a low level of hemoglobin overaging 6.5 g%. The urinalysis revealed an average SG of 1,010, without proteinuria or with slight proteinuria, lower than 500 mg in 24 hours. Three patients had microhematuria and the remainder had normal urinary sediment. A renal ultrasound in 18 cases revealed a bilateral reduction in the kidney size, loss of the cortcomedullar relation, an increase in the echogenety of the renal parenchyma, scattered in all cases, and the presence of corticomedullar cysts in 5 cases. The histopathological study performed in 8 cases revealed some findings which were compatible with chronic interstitial nephritis with corticomedullar cysts. The findings resemble those described in the literature in cases of familial juvenile nephronophthisis (FJN). An important aspect to be pointed out is the presence of an interstitial infiltrate with mononuclear cells, an even more significant feature than any previously reported. We can conclude that the members of these familial groups are carriers of FJN of recessive autosomic transmission, which, in view of some differences in the clinical presentation, age of onset of, CRI some biochemical and morphological findings, and the absence of genetic alterations as described in type 1 FJN, is a variant of this disease.
这是一项针对来自16个有共同家族谱系且患有慢性肾功能不全(CRI)的家庭的23名患者的研究。在这23名患者中,18名是女性,5名是男性,平均肾脏死亡年龄为18.4岁,呈现出多种临床表现。就诊的主要原因是贫血程度严重。17名患者动脉血压正常,1名患者表现为重度动脉高血压(AHT),3名表现为轻度AHT,2名表现为轻度AHT。所有患者均进入CRI终末期,血红蛋白水平较低,平均超过6.5 g%。尿液分析显示平均比重为1.010,无蛋白尿或仅有轻度蛋白尿,24小时低于500 mg。3名患者有镜下血尿,其余患者尿沉渣正常。18例患者的肾脏超声显示双侧肾脏大小减小,皮髓质分界消失,肾实质回声增强,所有病例均有散在表现,5例有皮髓质囊肿。8例患者进行的组织病理学研究显示了一些与伴有皮髓质囊肿的慢性间质性肾炎相符的发现。这些发现与文献中描述的家族性青少年肾单位肾痨(FJN)病例相似。需要指出的一个重要方面是存在单核细胞间质浸润,这一特征比以往报道的任何特征都更为显著。我们可以得出结论,这些家族群体的成员是隐性常染色体遗传的FJN携带者,鉴于临床表现、CRI发病年龄、一些生化和形态学发现存在一些差异,且不存在1型FJN中描述的基因改变,这是该疾病的一种变体。