Kusaba T, Nakayama M, Kato H, Uchiyama H, Sato K, Kajita Y
Division of Nephrology, Nantan General Hospital, Nantan, Japan.
Clin Nephrol. 2008 Jul;70(1):54-8. doi: 10.5414/cnp70054.
A 59-year-old woman was admitted to our hospital for treatment of acute renal insufficiency. She had been under home intravenous hyperalimentation therapy through a totally implantable central venous catheter for 2 years because of post-radiation enteritis. Clinical examination on admission revealed severe renal insufficiency complicated with hypocomplementemia, marked proteinuria and hematuria. Chest roentgenography demonstrated moderate pulmonary congestion. Hemodialysis was initiated and her pulmonary congestion improved. On the 14th and 21st hospital day, blood culture revealed Staphylococcus epidermidis colonization. Cefazolin was administered and C-reactive protein decreased, however, renal insufficiency and hypocomplementemia did not improve. To investigate the genesis of renal insufficiency, renal biopsy was performed. Light microscopic findings of the kidney revealed severe crescentic glomerulonephritis complicated with moderate tubulointerstitial damage. Immunofluorescence-microscopic findings of the kidney revealed positive IgG, IgM, C3 deposition along the capillary lumen. From these laboratory findings and the clinical course, we diagnosed her renal disease as crescentic glomerulonephritis induced by catheter-related bloodstream infection, and the central venous catheter was removed. After removal, urinary output and hypocomplementemia remarkably improved, however, unfortunately, her renal dysfunction did not improve and maintenance hemodialysis needed to be continued. Although her renal disease was not caused by ventriculo-atrial shunt but by central venous catheter-related bloodstream infection, we supposed that the pathogenesis was a closely similar entity to shunt nephritis.
一名59岁女性因急性肾功能不全入院治疗。由于放射性肠炎，她通过完全植入式中心静脉导管接受家庭静脉高营养治疗已达2年。入院时的临床检查发现严重肾功能不全并伴有补体血症、显著蛋白尿和血尿。胸部X线检查显示中度肺淤血。开始进行血液透析后，她的肺淤血情况有所改善。在住院第14天和第21天，血培养显示表皮葡萄球菌定植。给予头孢唑林后，C反应蛋白下降，但肾功能不全和补体血症并未改善。为了探究肾功能不全的病因，进行了肾活检。肾脏的光镜检查结果显示严重的新月体性肾小球肾炎并伴有中度肾小管间质损伤。肾脏免疫荧光显微镜检查结果显示沿毛细血管腔有IgG、IgM、C3阳性沉积。根据这些实验室检查结果和临床病程，我们将她的肾脏疾病诊断为导管相关血流感染所致的新月体性肾小球肾炎，并拔除了中心静脉导管。拔除导管后，尿量和补体血症显著改善，但遗憾的是，她的肾功能障碍并未改善，仍需继续维持血液透析。尽管她的肾脏疾病并非由脑室-心房分流引起，而是由中心静脉导管相关血流感染所致，但我们认为其发病机制与分流性肾炎极为相似。
