肾移植中对利妥昔单抗有反应的难治性复发性膜增生性肾小球肾炎：病例报告

Treatment-resistant recurrent membranoproliferative glomerulonephritis in renal allograft responding to rituximab: case report.

作者信息

Farooqui M, Alsaad K, Aloudah N, Alhamdan H

机构信息

Division of Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Department of Pathology and Laboratory Medicine, King Abdullah International Medical Research Center and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

出版信息

Transplant Proc. 2015 Apr;47(3):823-6. doi: 10.1016/j.transproceed.2015.02.003.

DOI:10.1016/j.transproceed.2015.02.003

PMID:25891740

Abstract

We report a case of idiopathic membranoproliferative glomerulonephritis (MPGN) recurring 2 years after a living-unrelated kidney transplantation. The disease was refractory to intravenous immunoglobulin and plasmapheresis. Treatment with 2 doses of rituximab resulted in remission of the disease. The disease relapsed 18 months later after an episode of cytomegalovirus pneumonitis. After treatment of the pneumonitis, a lung biopsy was performed owing to persistent chest symptoms, which revealed bronchiolitis obliterans with organizing pneumonia. Bone marrow examination and culture revealed presence of acid-fast bacilli, and culture grew Mycobacterium tuberculosis. A repeated course of rituximab was withheld because of infection with tuberculosis, the patient's chest symptoms, and rare reports of noninfectious lung disease after the use of rituximab. The patient continues to have proteinuria with impaired kidney function.

摘要

我们报告一例非亲属活体肾移植术后2年复发的特发性膜增生性肾小球肾炎（MPGN）。该疾病对静脉注射免疫球蛋白和血浆置换治疗无效。两剂利妥昔单抗治疗使疾病缓解。18个月后，在发生巨细胞病毒性肺炎后疾病复发。肺炎治疗后，由于持续的胸部症状进行了肺活检，结果显示为闭塞性细支气管炎伴机化性肺炎。骨髓检查和培养发现抗酸杆菌，培养物培养出结核分枝杆菌。由于结核感染、患者的胸部症状以及使用利妥昔单抗后非感染性肺部疾病的罕见报道，未再次使用利妥昔单抗疗程。患者肾功能受损，持续存在蛋白尿。