Parsons Elizabeth, Gupta Pankaj, Patel Prashanth, Rahman Faizanur
University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine , Level 4, Sandringham Building , Leicester Royal Infirmary , UK.
Oxf Med Case Reports. 2016 Oct 1;2016(10):omw076. doi: 10.1093/omcr/omw076. eCollection 2016 Oct.
A 68-year-old woman was referred to Lipid Clinic with sudden deterioration of previously well-controlled primary hyperlipidaemia. Investigations revealed nephrotic range proteinuria, leading to urgent renal biopsy and a diagnosis of amyloidosis. Chemotherapy was successful in stabilising renal function, reducing proteinuria and eliminating serum paraprotein. The resistant hyperlipidaemia subsequently resolved. Whilst hyperlipidaemia is pathognomonic of nephrotic syndrome, it is rarely the first characteristic identified by clinicians, often preceded by the identification of oedema or proteinuria. This case is an unusual example of a nephrotic syndrome presenting to Lipid Clinic as a resistant primary hyperlipidaemia, and highlights the importance of considering superimposed secondary causes of hyperlipidaemia in treatment resistant cases.
一名68岁女性因之前控制良好的原发性高脂血症突然恶化而被转诊至脂质门诊。检查发现肾病范围蛋白尿，遂紧急进行肾活检并诊断为淀粉样变性。化疗成功稳定了肾功能，减少了蛋白尿并消除了血清副蛋白。耐药性高脂血症随后得到缓解。虽然高脂血症是肾病综合征的特征性表现，但它很少是临床医生首先发现的特征，通常在发现水肿或蛋白尿之前出现。该病例是肾病综合征以耐药性原发性高脂血症形式出现在脂质门诊的一个不寻常例子，并强调了在治疗耐药病例时考虑高脂血症叠加继发性病因的重要性。
