Iwakura Takamasa, Namikawa Akio, Tsuji Naoko, Ishigaki Sayaka, Isobe Shinsuke, Ono Masafumi, Sakao Yukitoshi, Tsuji Takayuki, Ohashi Naro, Kato Akihiko, Goto Mana, Yasuda Hideo
Division of Nephrology, First Department of Medicine, Hamamatsu University School of Medicine, Japan.
Intern Med. 2015;54(22):2885-91. doi: 10.2169/internalmedicine.54.5015. Epub 2015 Nov 15.
A 73-year-old man with fever, renal insufficiency, and purpura was referred to our hospital to be evaluated for renal insufficiency. Renal biopsy revealed acute and chronic tubulointerstitial nephritis with no laboratory findings of sarcoidosis or connective tissue disease. Low C4 levels and elevation of rheumatoid factors suggested cryoglobulinemia, which was confirmed with quantitative analysis. CD34 staining of kidney tissue revealed peritubular capillaritis. Antineutrophil cytoplasmic antibodies were negative. The etiology of peritubular capillaritis was not clear in our patient; however, it might be associated with cryoglobulinemia because we cannot find any other diseases that could have induced the peritubular capillaritis.
一名73岁男性，伴有发热、肾功能不全和紫癜，因肾功能不全被转诊至我院进行评估。肾活检显示急性和慢性肾小管间质性肾炎，无结节病或结缔组织病的实验室检查结果。低C4水平和类风湿因子升高提示冷球蛋白血症，定量分析证实了这一点。肾组织的CD34染色显示肾小管周围毛细血管炎。抗中性粒细胞胞浆抗体为阴性。在我们的患者中，肾小管周围毛细血管炎的病因尚不清楚；然而，它可能与冷球蛋白血症有关，因为我们找不到任何其他可导致肾小管周围毛细血管炎的疾病。
