Li Fei-Ching, Hwang Daw-Yang, Hung Chi-Chih, Chen Hung-Chun
Department of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2008 Oct;24(10):531-5. doi: 10.1016/S1607-551X(09)70012-9.
A 26-year-old female with systemic lupus erythematosus was admitted because of dyspnea and progressive lower extremity edema. Laboratory testing showed blood urea nitrogen levels of 147 mg/dL, creatinine of 6.7 mg/dL, serum albumin of 1.7 g/dL and the daily protein loss was 12.7 g. Her C3 level was 60.4mg/dL and C4 level was 10.2 mg/dL. The antinuclear antibody titer was 1:320, with a homogeneous pattern, but she was negative for anti-dsDNA. ELISA testing for anti-PR3 antibodies and anti-MPO antibodies were all negative. She was also negative for circulating lupus anticoagulant. Renal biopsy revealed diffuse proliferation of glomerular cells, but immunofluorescent microscopy showed no immune deposits and electron microscopy revealed only scanty electron-dense deposits. She received 1 g/day of methylprednisolone intravenously for 3 days, followed by 60 mg/day of prednisolone. She was discharged with serum creatinine decreased to 4.7 mg/dL, and a great improvement in dyspnea. Diffuse proliferative lupus nephritis that contains little or no subendothelial deposits is rare. The differential diagnosis, possible mechanisms and treatment are discussed.
一名26岁的系统性红斑狼疮女性因呼吸困难和进行性下肢水肿入院。实验室检查显示血尿素氮水平为147mg/dL，肌酐为6.7mg/dL，血清白蛋白为1.7g/dL，每日蛋白丢失量为12.7g。她的C3水平为60.4mg/dL，C4水平为10.2mg/dL。抗核抗体滴度为1:320，呈均质型，但抗双链DNA阴性。抗蛋白酶3抗体和抗髓过氧化物酶抗体的ELISA检测均为阴性。循环狼疮抗凝物检测也为阴性。肾活检显示肾小球细胞弥漫性增生，但免疫荧光显微镜检查未发现免疫沉积物，电子显微镜检查仅发现少量电子致密沉积物。她接受了3天每天1g的静脉注射甲泼尼龙治疗，随后改为每天60mg的泼尼松龙治疗。出院时血清肌酐降至4.7mg/dL，呼吸困难有明显改善。几乎没有或没有内皮下沉积物的弥漫性增殖性狼疮性肾炎很少见。本文讨论了其鉴别诊断、可能机制及治疗方法。
