Sellin L, Quack I, Weiner S M, Waldherr R, Henning B, Hofebauer S, Rump L C
Department of Nephrology, Marienhospital Herne, Hospital of the University of Bochum, Herne, Germany.
Clin Nephrol. 2005 Aug;64(2):151-4. doi: 10.5414/cnp64151.
We report a case of a young man with a history of kidney stones. Occurrence of gross hematuria several months after the extracorporeal shock wave, lithotripsy (ESWL) treatment lead to hospitalization. By ultrasound and abdominal CT scan, the urologist could exclude post-renal causes of the gross hematuria and acute renal failure. After transfer to a department of nephrology hemodialysis was started, an immediate kidney biopsy was performed and prednisolone was administered on the same day. The kidney biopsy revealed an anti-glomerular basement membrane (GBM) disease. The renal function did not recover and the patient remained on hemodialysis. In the literature it has been hypothesized that ESWL-treated patients are prone to develop anti-GBM disease by liberation of glomerular basement antigen through the ESWL high energy shock waves. An additional hypothesis considering the higher susceptibility for anti-GBM disease among certain HLA-tissue types is discussed with regard to our case. Unfortunately, the prolonged track to diagnosis and delayed immunosuppressive treatment could not prevent poor clinical outcome. Although anti-GBM disease is a rather rare disease, it should be included as a differential diagnosis for hematuria--especially months after ESWL treatment. Otherwise early diagnosis may be missed and as in our patient immunosuppressive treatment will remain unsuccessful to recover renal function.
我们报告一例有肾结石病史的年轻男性病例。体外冲击波碎石术（ESWL）治疗数月后出现肉眼血尿，导致患者住院。通过超声和腹部CT扫描，泌尿外科医生排除了肉眼血尿和急性肾衰竭的肾后性病因。转至肾内科后开始进行血液透析，当天立即进行了肾活检并给予泼尼松龙。肾活检显示为抗肾小球基底膜（GBM）病。肾功能未恢复，患者继续接受血液透析。文献中推测，接受ESWL治疗的患者由于ESWL高能冲击波使肾小球基底膜抗原释放，因而易于发生抗GBM病。结合我们的病例，还讨论了另一种假说，即某些HLA组织类型的患者对抗GBM病的易感性更高。遗憾的是，诊断过程的延长和免疫抑制治疗的延迟未能阻止不良临床结局的发生。尽管抗GBM病是一种相当罕见的疾病，但对于血尿，尤其是ESWL治疗数月后的血尿，应将其列为鉴别诊断之一。否则可能会漏诊早期诊断，并且像我们的患者一样，免疫抑制治疗将无法成功恢复肾功能。
