Román E, Zamora I, Vera F
Servicio de Pediatría Hs Orihuela, Hospital Infantil La Fe.
Nefrologia. 2004;24(5):489-92.
Uveitis in children are less frequent than in adults. Their prognosis is variable because it may be found as an isolated and idiophatic condition or in association with definite clinical entities. The associated noninfectious diseases with predominantly renal involvement are tubulointerstitial nephritis and uveitis syndrome (TINU syndrome), mesangial glomerulonephritis isolated or in association with Behçet's disease. A case of 14-years-old girl with intermediate uveitis (pars planitis) and mesangial glomerulonephritis is presented. The ocular symptoms was eye redness and ocular pain and she has snow-banks in pars plana. She showed microscopic hematuria and intermitent proteinuria that increased during the ocular clinical exacerbation. Renal biopsy revealed both mild mesangial matrix increase and mesangial celullarity with normal tubulointerstitial structure and mesangial deposition of IgA and IgG immunoglobulins. This case is de first pediatric patient report in the literature with intermediate uveitis and mesangial glomerulonephritis with immune deposition. Mesangial glomerulonephritis were observed in patients whit Behçet disease, known etiological cause of uveitis in adults and children. These findings may suggest that uveitis and glomerulonephritis have common immunological pathogenesis including circulatory immune complexes. In uveitis patients, screening for associated extra-ocular and renal manifestations is mandatory and should have careful long-term follow-up with regular systemic evaluation.
儿童葡萄膜炎的发病率低于成人。其预后存在差异,因为它可能是一种孤立的特发性疾病,也可能与某些明确的临床病症相关。主要累及肾脏的相关非感染性疾病包括肾小管间质性肾炎和葡萄膜炎综合征(TINU综合征)、孤立性系膜增生性肾小球肾炎或与白塞病相关的系膜增生性肾小球肾炎。本文报告了一例14岁患有中间葡萄膜炎(睫状体平坦部炎)和系膜增生性肾小球肾炎的女孩。眼部症状为眼红和眼痛,睫状体平坦部可见雪堤样改变。她出现镜下血尿和间歇性蛋白尿,在眼部病情加重时增加。肾活检显示系膜基质轻度增加和系膜细胞增多,肾小管间质结构正常,系膜区有IgA和IgG免疫球蛋白沉积。该病例是文献中首例关于中间葡萄膜炎和伴有免疫沉积的系膜增生性肾小球肾炎的儿科患者报告。在白塞病患者中观察到系膜增生性肾小球肾炎,白塞病是成人和儿童葡萄膜炎的已知病因。这些发现可能提示葡萄膜炎和肾小球肾炎具有共同的免疫发病机制,包括循环免疫复合物。对于葡萄膜炎患者,必须筛查相关的眼外和肾脏表现,并应进行仔细的长期随访和定期的全身评估。