Nishioka Yoshiaki, Miyazaki Masanobu, Nishino Tomoya, Bando Yumiko, Harada Takashi, Taguchi Takashi, Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Nihon Jinzo Gakkai Shi. 2004 Oct;46(7):709-14.
A 48-year-old woman with systemic sclerosis (SSc) and rheumatoid arthritis was admitted to our hospital because of renal dysfunction. She had no hypertension at the time of admission and mild hypertension for only one and a half months until the time of admission. After admission, she received angiotensin-converting enzyme-inhibitor, but her renal dysfunction did not improve. She then had thrombotic microangiopathy with thrombocytopenia, and was treated with plasma exchange five times, but her renal dysfunction persisted. The renal biopsy specimens showed an arteriosclerotic lesion with intimal thickening and luminal narrowing and ischemic glomerular changes. These findings suggest that there is chronic vascular injury in a patient who has no hypertension with SSc and that once hypertension supervenes, whether severe or not, exacerbation of the vascular injury and renal dysfunction may occur.
一名患有系统性硬化症（SSc）和类风湿性关节炎的48岁女性因肾功能不全入住我院。入院时她没有高血压，入院前仅一个半月有轻度高血压。入院后，她接受了血管紧张素转换酶抑制剂治疗，但肾功能不全并未改善。随后她出现了伴有血小板减少的血栓性微血管病，并接受了5次血浆置换治疗，但肾功能不全仍持续存在。肾活检标本显示有动脉硬化病变，内膜增厚，管腔狭窄以及缺血性肾小球改变。这些发现表明，在没有高血压的SSc患者中存在慢性血管损伤，一旦出现高血压，无论严重程度如何，都可能导致血管损伤和肾功能不全加重。
