Zheng Wenjie, Li Guohua, Zhou Mengyu, Chen Limeng, Tian Xinping, Zhang Fengchun
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
Department of Nephrology, Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot, China.
Int J Rheum Dis. 2015 Nov;18(8):892-7. doi: 10.1111/1756-185X.12529. Epub 2015 Jan 3.
To investigate the clinical and pathological characteristics of renal involvement in Behcet's disease (BD).
A retrospective analysis was carried out in BD patients complicated with renal damage who were hospitalized in Peking Union Medical College Hospital from June 1998 to July 2012.
There were 16 BD patients with renal involvement, accounted for 2.6% of all the 618 hospitalized BD patients. The presentation of renal disease was chronic glomerulonephritis in six patients (including one with nephritic syndrome), renal tubular acidosis in one patient, renal artery stenosis in eight patients and renal vein thrombosis in one patient. Renal biopsy was performed in five patients, three of whom revealed to have minor glomerular lesions, mild mesangial proliferative glomerulonephritis and chronic tubular-interstitial nephropathy, respectively. The other two patients underwent a second biopsy, the one with minor glomerular lesion in the first biopsy was transformed into grade III immunoglobulin A (IgA) nephropathy on Lee's glomerular grading system 6 years later, and the other one who had IgA nephropathy of grade II in the first biopsy was progressed to grade IV 2 years later. Among the nine patients with renal vascular involvement, two underwent surgery, and several received anticoagulant therapy. During the follow-up of 13 patients, the urine protein quantifications were reduced, and renal function remained relatively stable.
Renal damage is relatively uncommon in BD patients. There are various clinical presentations of renal involvement in BD. Routine screening with urinalysis, serum creatinine and imaging studies should be carried out for the early diagnosis of renal involvement in BD.
探讨白塞病(BD)肾脏受累的临床及病理特征。
对1998年6月至2012年7月在北京协和医院住院的合并肾脏损害的BD患者进行回顾性分析。
16例BD患者出现肾脏受累,占618例住院BD患者的2.6%。肾脏疾病表现为6例慢性肾小球肾炎(其中1例为肾病综合征)、1例肾小管酸中毒、8例肾动脉狭窄和1例肾静脉血栓形成。5例患者进行了肾活检,其中3例分别显示轻微肾小球病变、轻度系膜增生性肾小球肾炎和慢性肾小管间质性肾病。另外2例患者进行了二次活检,第1次活检为轻微肾小球病变的患者6年后在Lee肾小球分级系统中转变为Ⅲ级免疫球蛋白A(IgA)肾病,第1次活检为Ⅱ级IgA肾病的患者2年后进展为Ⅳ级。9例肾血管受累患者中,2例接受了手术,数例接受了抗凝治疗。在13例患者的随访中,尿蛋白定量降低,肾功能保持相对稳定。
BD患者肾脏损害相对少见。BD肾脏受累有多种临床表现。应通过尿常规、血清肌酐及影像学检查进行常规筛查,以早期诊断BD肾脏受累。