Nishimura Satoshi, Miura Hideaki, Yamada Haruki, Shinoda Toshio, Kitamura Shigehiro, Miura Yasusada
Department of Internal Medicine, Social Insurance Chuo General Hospital, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.
J Gastroenterol. 2002;37(10):854-8. doi: 10.1007/s005350200141.
A 57-year-old woman was scheduled to receive recombinant interferon-alpha retreatment for chronic active hepatitis C. During the course of therapy, the patient showed rapid onset of oliguria, dizziness, edema, and a pre-shock state. She was subsequently admitted to hospital and was diagnosed as having nephrotic syndrome. After admission, albumin-dominant proteinuria persisted despite the discontinuation of interferon therapy. Light microscopy of a renal needle biopsy specimen showed interstitial lymphoid cell infiltration, but no marked changes of the glomeruli and no staining for immunoglobulin or complement. Electron microscopy showed diffuse effacement of the glomerular epithelial foot processes, leading to a diagnosis of minimal change nephrotic syndrome with interstitial nephritis. Proteinuria resolved after the initiation of oral prednisolone therapy (1 mg/kg per day). The number of patients with chronic hepatitis C requiring interferon retreatment is increasing rapidly. We herein report this rare case of acute onset of nephrotic syndrome during interferon-alpha retreatment.
一名57岁女性计划接受重组干扰素α再次治疗慢性活动性丙型肝炎。在治疗过程中，患者迅速出现少尿、头晕、水肿和休克前期状态。随后她被收治入院，被诊断为肾病综合征。入院后，尽管停用了干扰素治疗，但以白蛋白为主的蛋白尿持续存在。肾穿刺活检标本的光镜检查显示间质淋巴细胞浸润，但肾小球无明显变化，免疫球蛋白或补体无染色。电镜检查显示肾小球上皮足突弥漫性消失，诊断为微小病变型肾病综合征合并间质性肾炎。口服泼尼松龙治疗（每日1mg/kg）后蛋白尿消失。需要再次接受干扰素治疗的慢性丙型肝炎患者数量正在迅速增加。我们在此报告这例干扰素α再次治疗期间急性发作肾病综合征的罕见病例。
