Okada Akira, Yoshida Taiko, Takemura Koji, Ishigaki Kazuyoshi, Shimizu Akira, Takano Hideki
Department of Nephrology, Tokyo Teishin Hospital, 2. Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan.
Intern Med. 2015;54(10):1265-71. doi: 10.2169/internalmedicine.54.3525.
An 80-year-old man presented with a mildly decreased renal function and increased anti-double-stranded-DNA (anti-dsDNA) antibody levels, and met the diagnostic criteria of the American College of Rheumatology for systemic lupus erythematosus (SLE). However, the incremental increase in creatinine levels and the mild proteinuria were inconsistent with lupus nephritis. We performed a renal biopsy, which revealed interstitial nephritis and minor glomerular abnormalities. Further examinations determined that the renal lesion was due to Sjögren's syndrome secondary to SLE. Following treatment with oral prednisolone, the patient's renal function improved as his anti-dsDNA antibody levels decreased. This case report indicates that renal biopsy should be considered even in elderly individuals when it may assist in the diagnosis, treatment, and prognosis of the patient.
一名80岁男性,肾功能轻度下降,抗双链DNA(anti-dsDNA)抗体水平升高,符合美国风湿病学会系统性红斑狼疮(SLE)的诊断标准。然而,肌酐水平的逐渐升高和轻度蛋白尿与狼疮性肾炎不符。我们进行了肾活检,结果显示为间质性肾炎和轻微的肾小球异常。进一步检查确定肾脏病变是由SLE继发的干燥综合征所致。口服泼尼松龙治疗后,随着患者抗dsDNA抗体水平下降,其肾功能有所改善。本病例报告表明,即使是老年患者,当肾活检有助于患者的诊断、治疗及预后判断时,也应考虑进行。