Laraki R, Chauveau D, Noel L H, Hermine O
Cabinet de médecine interne, Casablanca, Maroc.
Presse Med. 2005 Sep 10;34(15):1069-72. doi: 10.1016/s0755-4982(05)84118-1.
Glomerulonephritis, mainly membranoproliferative or membranous (MG), is observed much less often than interstitial involvement in Sjögren's syndrome (SS).
We report a case of MG revealed by thrombosis of the inferior vena cava and of a renal vein in a 40-year-old woman with primary SS, which began with polyarthritis, immune-type lymphadenopathy, and Hashimoto thyroiditis and did not include obvious sicca syndrome. After failure of moderate-dose steroids and then azathioprine, each over separate 9-month periods, the MG responded well within a few weeks to monthly alternation of methylprednisolone and oral cyclophosphamide for 6 months.
SS may be an underestimated cause of glomerulonephritis, especially membranoproliferative and membranous glomerulonephritis. They should be considered even in the absence of obvious sicca syndrome. Although the prognosis is usually good, renal insufficiency can occur. In cases of MG, if moderate-dose steroids fail, monthly alternation of methylprednisolone and cyclophosphamide for 6 months appears effective and well tolerated, with a low risk of carcinogenicity.
肾小球肾炎，主要是膜增生性或膜性（MG），在干燥综合征（SS）中比间质性病变少见得多。
我们报告一例40岁原发性干燥综合征女性患者，其下腔静脉和肾静脉血栓形成提示患有MG。该患者最初表现为多关节炎、免疫型淋巴结病和桥本甲状腺炎，无明显干燥综合征。在分别使用中等剂量类固醇和硫唑嘌呤治疗9个月均失败后，MG在数周内对甲基强的松龙和口服环磷酰胺每月交替治疗6个月反应良好。
干燥综合征可能是肾小球肾炎尤其是膜增生性和膜性肾小球肾炎的一个被低估的病因。即使没有明显干燥综合征也应考虑到它们。虽然预后通常良好，但仍可能发生肾功能不全。对于MG病例，如果中等剂量类固醇治疗失败，甲基强的松龙和环磷酰胺每月交替治疗6个月似乎有效且耐受性良好，致癌风险低。
