Takeuchi Yasuo, Takeuchi Emiko, Kamata Kouju
Division of Nephrology, Department of Internal Medicine, Sagamihara, Japan.
Department of Immunology, Kitasato University School of Medicine, Sagamihara, Japan.
Case Rep Nephrol Dial. 2015 Mar 31;5(1):87-95. doi: 10.1159/000381396. eCollection 2015 Jan-Apr.
Anti-glomerular basement membrane (anti-GBM) antibody-mediated glomerulonephritis (anti-GBM GN) is an autoimmune disease with rapidly progressive glomerulonephritis. Based on a case report of anti-GBM GN following hydronephrosis, we hypothesized that hydronephrosis may act as a trigger for the development of anti-GBM antibodies.
We evaluated 11 patients who were diagnosed with hydronephrosis. It was measured with serum anti-GBM antibody. These patients' medical histories as well as risk factors for the development of anti-GBM antibodies and causes of hydronephrosis were reviewed. Renal function and hematuria were also considered. The serum anti-GBM antibody was measured with enzyme-linked immunosorbent assays (ELISA) or chemiluminescent enzyme immunoassays (CLEIA). Histopathological findings of renal biopsy specimens were also evaluated.
No patient had a medical history of renal disease. Five patients had a history of smoking. Ten of the 11 patients had renal dysfunction as evidenced by serum creatinine levels of 0.85-13.8 mg/dl, while 8 patients had RBCs in their urinary sediment at the time of diagnosis for hydronephrosis. Two of the patients assessed by ELISA and CLEIA were positive for anti-GBM antibodies. In 1 of these 3 patients, anti-GBM antibodies and renal dysfunction improved upon treatment for hydronephrosis. Another of the 3 patients developed anti-GBM GN, but anti-GBM antibodies and renal dysfunction improved dramatically upon treatment. In the 3rd patient without improved hydronephrosis, anti-GBM antibodies and renal dysfunction remained unchanged.
Our results provide insights into the development of anti-GBM antibodies in patients with ureteral obstruction and hydronephrosis.
抗肾小球基底膜（anti-GBM）抗体介导的肾小球肾炎（抗GBM GN）是一种伴有快速进展性肾小球肾炎的自身免疫性疾病。基于一例肾积水后发生抗GBM GN的病例报告，我们推测肾积水可能是抗GBM抗体产生的触发因素。
我们评估了11例被诊断为肾积水的患者。检测其血清抗GBM抗体。回顾了这些患者的病史以及抗GBM抗体产生的危险因素和肾积水的病因。还考虑了肾功能和血尿情况。采用酶联免疫吸附测定（ELISA）或化学发光酶免疫测定（CLEIA）检测血清抗GBM抗体。同时评估了肾活检标本的组织病理学结果。
所有患者均无肾脏疾病病史。5例患者有吸烟史。11例患者中有10例存在肾功能不全，血清肌酐水平为0.85 - 13.8 mg/dl，8例患者在诊断肾积水时尿沉渣中有红细胞。通过ELISA和CLEIA检测的患者中有2例抗GBM抗体呈阳性。在这3例患者中，有1例在治疗肾积水后抗GBM抗体和肾功能不全有所改善。3例患者中的另1例发展为抗GBM GN，但经治疗后抗GBM抗体和肾功能不全显著改善。第3例患者肾积水未改善，抗GBM抗体和肾功能不全保持不变。
我们的结果为输尿管梗阻和肾积水患者抗GBM抗体的产生提供了见解。
