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一例抗肾小球基底膜肾小球肾炎合并1型糖尿病,酷似尿路感染

A Case of Anti-Glomerular Basement Membrane Glomerulonephritis Complicated by Type 1 Diabetes Mellitus, Mimicking Urinary Tract Infection.

作者信息

Aoki Yoshihiro, Tanimoto Izumi, Miyauchi Yoshihiro, Suzuki Yoshio, Shiojiri Toshiaki

机构信息

Department of Internal Medicine, Asahi General Hospital, Chiba, Japan.

Department of Nephrology, Asahi General Hospital, Chiba, Japan.

出版信息

Am J Case Rep. 2017 Mar 27;18:308-312. doi: 10.12659/ajcr.902590.

Abstract

BACKGROUND Type 1 diabetes mellitus (DM) tends to complicate other autoimmune diseases. When considering renal dysfunction in patients with DM, diabetic nephropathy is a likely diagnosis. By contrast, anti-glomerular basement membrane (GBM) glomerulonephritis, an autoimmune disease, is one cause of rapidly progressive glomerulonephritis. CASE REPORT We report the case of a 44-year-old woman diagnosed with anti-glomerular basement membrane (GBM) glomerulonephritis. The diagnosis was made on the basis of serological test results and pathological findings of a renal biopsy. Five years before admission, she was diagnosed with type 1 DM. At admission, she presented with a fever, chills, nausea, low back pain, and malaise, which were followed by progressive renal dysfunction. The initial presentation mimicked a urinary tract infection, which delayed the correct diagnosis. CONCLUSIONS Our patient's course strongly suggests that rapidly progressive glomerulonephritis should be considered as an early differential diagnosis in cases of progressive renal dysfunction, especially when accompanied by fever, regardless of the underlying disease.

摘要

背景 1 型糖尿病(DM)往往会并发其他自身免疫性疾病。在考虑 DM 患者的肾功能障碍时,糖尿病肾病是一个可能的诊断。相比之下,抗肾小球基底膜(GBM)肾小球肾炎作为一种自身免疫性疾病,是快速进展性肾小球肾炎的病因之一。病例报告 我们报告一例 44 岁女性被诊断为抗肾小球基底膜(GBM)肾小球肾炎的病例。该诊断基于血清学检测结果和肾活检的病理发现。入院前 5 年,她被诊断为 1 型 DM。入院时,她出现发热、寒战、恶心、腰痛和不适,随后出现进行性肾功能障碍。最初的表现类似尿路感染,这延误了正确诊断。结论 我们患者的病程强烈提示,对于出现进行性肾功能障碍的病例,尤其是伴有发热时,无论潜在疾病如何,快速进展性肾小球肾炎都应作为早期鉴别诊断予以考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1574/5378297/6c575ef7ce6d/amjcaserep-18-308-g001.jpg

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