Lui Sing Leung, Chan Kwok Wah, Yip Pok Siu, Chan Tak Mao, Lai Kar Neng, Lo Wai Kei
Department of Medicine, Tung Wah Hospital, Hong Kong, China.
Am J Kidney Dis. 2002 Oct;40(4):E14. doi: 10.1053/ajkd.2002.35704.
We report the case of a 72-year-old woman with a long-standing history of diabetes mellitus who presented with heavy proteinuria and rapid deterioration in renal function. She had a high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). The renal biopsy specimen revealed features of diabetic glomerulosclerosis, crescentic glomerulonephritis, and IgA nephropathy. Treatment with steroid and cyclophosphamide resulted in significant improvement in renal function and normalization of MPO-ANCA level. This case highlights the importance of having a high index of suspicion for coexisting glomerulonephritis in diabetic patients presenting with proteinuria. The clinical course of patients with diabetic glomerulosclerosis, IgA nephropathy, crescentic glomerulonephritis, and MPO-ANCA seropositivity seems to resemble that of ANCA-associated, rapidly progressive glomerulonephritis and is potentially amenable to aggressive immunosuppressive therapy.
我们报告了一例72岁女性患者，该患者有长期糖尿病病史，出现大量蛋白尿且肾功能迅速恶化。她的髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）滴度很高。肾活检标本显示有糖尿病肾小球硬化、新月体性肾小球肾炎和IgA肾病的特征。使用类固醇和环磷酰胺治疗后，肾功能显著改善，MPO-ANCA水平恢复正常。该病例强调了对于出现蛋白尿的糖尿病患者合并肾小球肾炎要有高度怀疑指数的重要性。糖尿病肾小球硬化、IgA肾病、新月体性肾小球肾炎和MPO-ANCA血清阳性患者的临床病程似乎与ANCA相关的快速进展性肾小球肾炎相似，并且可能适合积极的免疫抑制治疗。
