Nagatoya Katsuyuki
Department of Nephrology, Osaka Medical College Hospital.
Nihon Ronen Igakkai Zasshi. 2010;47(5):468-73. doi: 10.3143/geriatrics.47.468.
The case was a female in her early 80's. Due to abdominal bloating and lower limb edema, she visited a nearby doctor, was diagnosed to have nephrotic syndrome, and then was referred to our department. Upon initial consultation, TP of 4.1 g/dl, Alb of 1.7 g/dl, UN of 73 mg/dl, and Cr of 1.43 mg/dl, along with pleural effusion were observed by chest X-ray. A renal biopsy was not performed because permission could not be obtained. Despite the fact that management of the edema was performed using diuretic agents and albumin preparations, a reduced renal function and deterioration of the fluid retention were gradually observed. She originally displayed lower back pain and digestive symptoms and, therefore, cyclosporine monotherapy was initiated in order to address concerns of side effects such as osteoporosis and peptic ulcer due to adrenocortical steroid drugs (hereinafter abbreviated as steroid). Subsequently, hemodialysis was temporarily required but reduced urine protein and an improved renal function were gradually observed and she eventually achieved a complete remission. The possibility of a spontaneous remission of membranous nephropathy, etc. was considered, but a relapse occurred when the amount of cyclosporine was reduced. Thereafter, a complete remission was obtained with an increased dosage. As a result, the effectiveness of cyclosporine was thus confirmed. In treating nephrotic syndrome, steroid therapy is commonly performed and it is common for cyclosporine to be limited to steroid-resistant cases and/or steroid-dependent cases. However, it is believed that monotherapy could also be an option in cases in which the use of steroids is difficult, such as in cases of elderly patients.
该病例为一名80岁出头的女性。因腹胀和下肢水肿，她前往附近就医，被诊断为肾病综合征，随后转诊至我科。初诊时，观察到总蛋白（TP）为4.1g/dl，白蛋白（Alb）为1.7g/dl，尿素氮（UN）为73mg/dl，肌酐（Cr）为1.43mg/dl，胸部X光显示有胸腔积液。由于未获得许可，未进行肾活检。尽管使用利尿剂和白蛋白制剂对水肿进行了处理，但肾功能仍逐渐下降，液体潴留情况也逐渐恶化。她最初表现出腰痛和消化系统症状，因此开始采用环孢素单一疗法，以解决因肾上腺皮质类固醇药物（以下简称类固醇）导致的骨质疏松和消化性溃疡等副作用问题。随后，暂时需要进行血液透析，但逐渐观察到尿蛋白减少，肾功能有所改善，最终实现了完全缓解。考虑到膜性肾病等有自发缓解的可能性，但当环孢素剂量减少时病情复发。此后，增加剂量后再次实现了完全缓解。结果，证实了环孢素的有效性。在治疗肾病综合征时，通常采用类固醇疗法，环孢素通常仅限于类固醇抵抗型病例和/或类固醇依赖型病例。然而，对于使用类固醇困难的病例，如老年患者，单一疗法也可能是一种选择。
