Singh N P, Prakash Anupam, Kubba Samir, Ganguli Anirban, Singh Anil K, Sikdar Sunandan, Agarwal Satish K, Dinda Amit K, Grover Chander
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Ren Fail. 2005;27(1):123-7.
Psoriasis is an immune-mediated chronic inflammatory disorder of the skin. Association with kidney disease has been debated for a long time. Secondary renal amyloidosis in psoriatic arthropathy and drug-induced renal lesions secondary to methotrexate or cyclosporine are accepted accompaniments of psoriasis. IgA nephropathy is also known to occur in psoriatics. We report three interesting cases of renal involvement in long-standing established psoriasis on topical therapy alone. The patients presented with hypertension, significant proteinuria, hypoalbuminemia, and dyslipidemia. Kidney biopsies revealed "mesangioproliferative glomerulonephritis with IgA nephropathy," "focal proliferative glomerulonephritis," and "membranous glomerulonephropathy." The former two had marked active urinary sediment. Patients improved on prednisolone and angiotensin-converting enzyme inhibitors. Contrary to the belief that renal involvement in psoriasis is coincidental, we propose that kidney disease may be a common accompaniment of psoriasis, which may be labeled as "psoriatic nephropathy" or "psoriatic kidney disease." The exact mechanism of this entity is yet to be elucidated.
银屑病是一种免疫介导的慢性皮肤炎症性疾病。其与肾脏疾病的关联长期以来一直存在争议。银屑病关节炎中的继发性肾淀粉样变性以及甲氨蝶呤或环孢素所致的药物性肾损害是银屑病公认的伴随病症。IgA肾病也见于银屑病患者。我们报告了3例仅接受局部治疗的长期确诊银屑病患者出现肾脏受累的有趣病例。这些患者表现为高血压、大量蛋白尿、低白蛋白血症和血脂异常。肾活检显示“系膜增生性肾小球肾炎伴IgA肾病”“局灶增生性肾小球肾炎”和“膜性肾小球肾病”。前两者有明显的活动性尿沉渣。患者使用泼尼松龙和血管紧张素转换酶抑制剂后病情改善。与银屑病肾脏受累是巧合的观点相反，我们提出肾脏疾病可能是银屑病常见的伴随病症，可将其命名为“银屑病肾病”或“银屑病性肾脏疾病”。该病症的确切机制尚待阐明。
