Gedalia A, Mendez E A, Craver R, Vehaskari M, Espinoza L R
Department of Pediatrics, LSU Health Sciences Center, New Orleans, Louisiana 70112-2822, USA.
Clin Rheumatol. 2001;20(2):153-6. doi: 10.1007/pl00011196.
Renal involvement is a rare occurrence in juvenile rheumatoid arthritis (JRA). We report on two JRA patients with kidney disease. The first was a 14-year-old African-American female with a 12-month history of polyarthritis. On presentation she was found to have an ESR of 127 mm/h and a positive ANA, rheumatoid factor (RF), perinuclear antineutrophil cytoplasmic antibodies (pANCA), haematuria, proteinuria with normal BUN and creatinine. Renal biopsy showed focal segmental glomerulosclerosis. Her renal function deteriorated to end-stage renal failure requiring dialysis within a few months, despite aggressive treatment with steorids and monthly i.v. pulses of cyclophosphamide. The second patient presented with a 6-week history of polyarthritis and intermittent fever, and had a salmon-coloured evanescent rash. On presentation his laboratory evaluation was significant for elevated ESR and negative ANA, RF and ANCA tests. Within 8 months the patient had developed a persistent microscopic haematuria. Renal biopsy showed mild mesangial glomerulonephritis. On low-dose methotrexate therapy his JRA went into remission and his renal function remained normal. The haematuria persisted for 1 year and then resolved spontaneously. This is the first time that focal segmental glomerulosclerosis and mesangial glomerulonephritis have been described in JRA. Although the association may be just coincidental, further studies are needed to define the role of JRA in these renal conditions. In patients with JRA, urinalysis and renal function should be routinely monitored.
肾脏受累在青少年类风湿关节炎（JRA）中较为罕见。我们报告了两名患有肾脏疾病的JRA患者。第一名患者是一名14岁的非裔美国女性，有多关节炎病史12个月。就诊时发现她的血沉为127mm/h，抗核抗体（ANA）、类风湿因子（RF）、核周抗中性粒细胞胞浆抗体（pANCA）呈阳性，有血尿、蛋白尿，而血尿素氮和肌酐正常。肾活检显示局灶节段性肾小球硬化。尽管积极使用类固醇治疗并每月静脉注射环磷酰胺冲击治疗，但她的肾功能在几个月内恶化为终末期肾衰竭，需要透析。第二名患者有多关节炎和间歇性发热病史6周，并有淡粉色的一过性皮疹。就诊时，他的实验室检查结果显示血沉升高，ANA、RF和ANCA检测均为阴性。8个月内，该患者出现了持续性镜下血尿。肾活检显示轻度系膜增生性肾小球肾炎。在低剂量甲氨蝶呤治疗下，他的JRA病情缓解，肾功能保持正常。血尿持续了1年，然后自行消失。这是首次在JRA中描述局灶节段性肾小球硬化和系膜增生性肾小球肾炎。尽管这种关联可能只是巧合，但仍需要进一步研究来确定JRA在这些肾脏疾病中的作用。对于JRA患者，应常规监测尿液分析和肾功能。
