Tsubata Yutaka, Akiyama Fumihiro, Oya Takeshi, Ajiro Junya, Saeki Takako, Nishi Shinichi, Narita Ichiei
Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu.
Intern Med. 2010;49(15):1593-8. doi: 10.2169/internalmedicine.49.3787. Epub 2010 Aug 2.
We report an elderly man with chronic tubulointerstitial nephritis (TIN) showing a high serum immunoglobulin G4 (IgG4) concentration. His serum creatinine (Scr) level had gradually increased from 0.9 mg/dL to 5.6 mg/dL over 18 months. Renal biopsy showed marked IgG4-positive plasma cell infiltration in the interstitium without glomerular abnormalities and IgG4-related TIN was diagnosed. Oral prednisolone reduced his Scr and IgG4 levels immediately. The present case indicates that IgG4-related TIN can not only progress rapidly but also chronically over a long period without significant urinary abnormalities, and we should consider hidden IgG4-related TIN in cases of chronic renal insufficiency.
我们报告了一名患有慢性肾小管间质性肾炎（TIN）的老年男性，其血清免疫球蛋白G4（IgG4）浓度较高。在18个月的时间里，他的血清肌酐（Scr）水平从0.9mg/dL逐渐升高至5.6mg/dL。肾活检显示间质中有明显的IgG4阳性浆细胞浸润，无肾小球异常，诊断为IgG4相关性TIN。口服泼尼松龙后，他的Scr和IgG4水平立即下降。本病例表明，IgG4相关性TIN不仅可迅速进展，而且可在很长一段时间内慢性进展，且无明显尿液异常，对于慢性肾功能不全患者，我们应考虑隐匿性IgG4相关性TIN。
