Koda Ryo, Yoshino Atsunori, Imanishi Yuji, Kawamoto Shinya, Ueda Yoshihiko, Kazama Junichiro James, Narita Ichiei, Takeda Tetsuro
Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
Case Rep Nephrol Urol. 2014 Apr 1;4(1):60-9. doi: 10.1159/000360850. eCollection 2014 Jan.
Glomerulonephropathy is a rare complication of Takayasu's arteritis (TA). To date, most glomerulonephropathies associated with TA show the histological feature of mesangial proliferation. Membranous glomerulonephropathy (MG) is a form of glomerulonephropathy in which the mesangial proliferation is not conspicuous and its association with TA is extremely rare. A 54-year-old man was referred to our hospital due to progressive edema in the lower limbs and nephrotic range proteinuria. Five years previously, he underwent percutaneous angioplasty for left subclavian artery stenosis. Kidney biopsy revealed stage II MG. General examination including enhanced CT scan confirmed the presence of TA. He started oral prednisolone therapy at a dose of 40 mg daily. The C-reactive protein level normalized 7 days after the prednisolone therapy. Three months later, proteinuria had remitted. Though the true relationship between MG and TA was not revealed in present case, considering the fact that complete remission of nephrotic syndrome occurred following the improvement of C-reactive protein level in response to steroid therapy, TA might be the secondary cause of MG. To our best knowledge, only two case reports described the association of MG and TA previously. Those two patients, however, also demonstrated the feature of systemic lupus erythematosus in addition to TA. This is the first case report that describes a patient who presented as MG associated with TA, but not complicated by systemic lupus erythematosus.
肾小球肾病是大动脉炎（TA）的一种罕见并发症。迄今为止，大多数与TA相关的肾小球肾病表现为系膜增生的组织学特征。膜性肾小球肾病（MG）是一种肾小球肾病，其中系膜增生不明显，其与TA的关联极为罕见。一名54岁男性因下肢进行性水肿和肾病范围蛋白尿被转诊至我院。5年前，他因左锁骨下动脉狭窄接受了经皮血管成形术。肾活检显示为II期MG。包括增强CT扫描在内的全身检查证实存在TA。他开始口服泼尼松龙治疗，剂量为每日40mg。泼尼松龙治疗7天后，C反应蛋白水平恢复正常。3个月后，蛋白尿缓解。尽管本病例中MG与TA之间的真正关系尚未明确，但考虑到对类固醇治疗反应的C反应蛋白水平改善后肾病综合征完全缓解这一事实，TA可能是MG的继发原因。据我们所知，此前仅有两篇病例报告描述了MG与TA的关联。然而，这两名患者除了TA外还表现出系统性红斑狼疮的特征。这是首例描述表现为与TA相关的MG但未并发系统性红斑狼疮的患者的病例报告。
