Kondo H, Uga S, Kaihara A, Kawada M, Yamano T
Department of Internal Medicine, Sakawa Town Kohoku National Health Insurance Hospital.
Nihon Jinzo Gakkai Shi. 1990 Jul;32(7):835-40.
A case of paroxysmal nocturnal hemoglobinuria (PNH) associated with acute renal failure (ARF) is described. A 57-year-old female, who had been diagnosed as having PNH in 1983 at Kochi Medical School, was admitted to our hospital in April 1989, because of ARF with dark urine after a common cold. Hemodialysis was performed 5 times for ARF, and after almost completely recovering from ARF, she was discharged. The renal biopsy showed the deposition of hemosiderin in the proximal tubular cells. We surveyed fourteen case reports of PNH associated with ARF in Japan including our case. Ten cases developed ARF after infection causing hemolytic attack. Twelve of 14 cases were treated by hemodialysis and 13 cases were reversible. The histopathology of their renal biopsies revealed the deposition of hemosiderin in the proximal tubular cells in six of seven cases and tubular necrosis in three cases. These data showed that hemolytic attack and dehydration related to infection facilitated the induction of ARF.
本文描述了一例阵发性睡眠性血红蛋白尿（PNH）合并急性肾衰竭（ARF）的病例。一名57岁女性，1983年在高知医科大学被诊断为PNH，1989年4月因感冒后出现急性肾衰竭伴深色尿入住我院。因急性肾衰竭进行了5次血液透析，在急性肾衰竭基本完全恢复后出院。肾活检显示近端肾小管细胞中有含铁血黄素沉积。我们调查了包括我们的病例在内的日本14例PNH合并ARF的病例报告。10例在感染导致溶血发作后发生急性肾衰竭。14例中有12例接受了血液透析治疗，13例病情可逆。他们肾活检的组织病理学显示，7例中有6例近端肾小管细胞中有含铁血黄素沉积，3例有肾小管坏死。这些数据表明，与感染相关的溶血发作和脱水促进了急性肾衰竭的发生。
