Nakayama M, Nagata M, Hirano T, Sugai K, Katafuchi R, Imayama S, Uesugi N, Tsuchihashi T, Kumagai H
Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
Clin Nephrol. 2006 Oct;66(4):232-9. doi: 10.5414/cnp66232.
The prognosis of renal cholesterol crystal embolism (CCE) is poor. Although various treatments for CCE have been attempted, there is no optimal therapy. We tested the effect of low-dose prednisolone (PS) on CCE-related acute renal failure (ARF).
7 patients (mean age 69 years) diagnosed with CCE-related ARF were treated with oral PS at 15-20 mg/day for 2-4 weeks, which was then tapered at 5 mg/day over 2-4 weeks, followed by 5 mg/day maintenance dose. Recurrent ARF during PS tapering was treated with a larger dose of PS.
Inciting factors were identified in four patients: coronary angiography (n=3) and cerebral angiography (n=1). On admission, serum creatinine (SCr) was 2.1 +/- 0.3 mg/dl (mean +/- SEM). SCr and eosinophil count before treatment were 4.2 +/- 0.4 mg/dl and 682 +/- 73/microl, respectively. PS therapy improved ARF in all cases at week 2 (SCr 3.8 +/- 0.5 mg/dl) parallel to a decrease in eosinophilia (116 +/- 30/microl), and at week 4 (3.1 +/- 0.4 mg/dl and 134 +/- 20/microl, respectively). At last follow-up, renal function was improved or maintained in 5 patients compared with that at week 4 post-treatment. One patient died of lung cancer. Another required LDL apheresis and hemodialysis but died due to CCE-related multi-organ failure. A third patient had recurrent ARF and was re-treated with a larger dose of PS, which resulted in an immediate decrease in SCr. However, the patient developed acute renal dysfunction due to congestive heart failure, and required hemodialysis.
Low-dose PS improved CCE-related ARF, probably through amelioration of inflammatory reaction surrounding affected renal vessels.
肾胆固醇结晶栓塞（CCE）的预后较差。尽管已经尝试了多种治疗CCE的方法，但尚无最佳疗法。我们测试了低剂量泼尼松龙（PS）对CCE相关急性肾衰竭（ARF）的疗效。
7例诊断为CCE相关ARF的患者（平均年龄69岁）接受口服PS治疗，剂量为15 - 20mg/天，持续2 - 4周，然后在2 - 4周内以5mg/天的剂量逐渐减量，随后维持剂量为5mg/天。在PS减量期间复发的ARF用更大剂量的PS治疗。
在4例患者中确定了诱发因素：冠状动脉造影（n = 3）和脑血管造影（n = 1）。入院时，血清肌酐（SCr）为2.1±0.3mg/dl（平均值±标准误）。治疗前SCr和嗜酸性粒细胞计数分别为4.2±0.4mg/dl和682±73/μl。PS治疗在第2周时改善了所有病例的ARF（SCr为3.8±0.5mg/dl），同时嗜酸性粒细胞增多症有所减轻（116±30/μl），在第4周时（分别为3.1±0.4mg/dl和134±20/μl）。在最后一次随访时，与治疗后第4周相比，5例患者的肾功能得到改善或维持。1例患者死于肺癌。另1例患者需要进行低密度脂蛋白分离术和血液透析，但因CCE相关多器官衰竭死亡。第3例患者出现复发性ARF，再次用更大剂量的PS治疗，导致SCr立即下降。然而，该患者因充血性心力衰竭发展为急性肾功能不全，需要进行血液透析。
低剂量PS改善了CCE相关的ARF，可能是通过改善受影响肾血管周围的炎症反应实现的。
