Duvic C, Desramé J, Hérody M, Nédélec G
Clinique de Néphrologie et Unité d'Hémodialyse, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.
Clin Nephrol. 2000 Aug;54(2):169-73.
The simultaneous occurrence of acute poststreptococcal glomerulonephritis and thrombotic microangiopathy is rare. A 47-year-old woman was admitted with acute renal failure, hematuria, edematous nephrotic syndrome and severe hypertension. This acute nephritic syndrome occurred two weeks after left leg erysipelas. The patient also had signs of intravascular hemolysis, low serum levels of C3 and C4 and elevated antistreptolysin-O titer. Kidney biopsy confirmed postinfectious glomerulonephritis with diffuse hypercellularity and humps, and simultaneous subendothelial hyalin deposits and fibrinoid arteriolar thrombi. The patient received four antihypertensive drugs, acetylsalicyclic acid and plasma infusions. Renal function improved, hypertension was controlled and serum levels of C3 and C4 complement components returned to normal within three months. This case illustrates the occurrence of thrombotic microangiopathy in association with acute poststreptococcal glomerulonephritis. This simultaneous appearance supports a role of neuraminidase in this disease.
急性链球菌感染后肾小球肾炎与血栓性微血管病同时发生的情况较为罕见。一名47岁女性因急性肾衰竭、血尿、水肿性肾病综合征和严重高血压入院。这种急性肾炎综合征在左腿丹毒发作两周后出现。患者还存在血管内溶血迹象、血清C3和C4水平降低以及抗链球菌溶血素O滴度升高。肾活检证实为感染后肾小球肾炎，表现为弥漫性细胞增多和驼峰形成，同时伴有内皮下透明样沉积物和纤维样小动脉血栓。患者接受了四种降压药物、乙酰水杨酸和血浆输注治疗。肾功能得到改善，高血压得到控制，血清C3和C4补体成分在三个月内恢复正常。该病例说明了血栓性微血管病与急性链球菌感染后肾小球肾炎相关的发生情况。这种同时出现支持了神经氨酸酶在该疾病中的作用。
