Ando Fumiaki, Okado Tomokazu, Sohara Eisei, Rai Tatemitsu, Uchida Shinichi, Sasaki Sei
Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
CEN Case Rep. 2013 Nov;2(2):248-251. doi: 10.1007/s13730-013-0072-3. Epub 2013 Mar 17.
Minimal-change glomerular disease, sarcoidosis and autoimmune thyroid disease rarely occur in the same patient. We herein report a patient in which minimal-change glomerular disease and Hashimoto's thyroiditis developed during the treatment of sarcoidosis with steroids. A 66-year-old female was admitted to our hospital with symptoms of nephrotic syndrome. Nine months before admission, she was diagnosed as having ocular and pulmonary sarcoidosis, for which prednisolone at an initial dose of 40 mg/day was started. When the dose of prednisolone was tapered to 20 mg/day, she noticed swelling of the lower extremities. Examination confirmed the simultaneous occurrence of minimal-change glomerular disease and Hashimoto's thyroiditis, which were diagnosed based on kidney histology, ultrasonography of the thyroid gland and positive antithyroglobulin antibodies. We used intravenous methylprednisolone pulse therapy followed by 40 mg/day oral prednisolone. The patient achieved complete remission of nephrotic syndrome and steroids were tapered without relapse.
微小病变型肾小球病、结节病和自身免疫性甲状腺疾病很少在同一患者中出现。我们在此报告一名患者，其在使用类固醇治疗结节病期间发生了微小病变型肾小球病和桥本甲状腺炎。一名66岁女性因肾病综合征症状入住我院。入院前9个月，她被诊断为眼和肺结节病，开始使用初始剂量为40mg/天的泼尼松龙治疗。当泼尼松龙剂量减至20mg/天时，她注意到下肢肿胀。检查证实同时发生了微小病变型肾小球病和桥本甲状腺炎，这是根据肾脏组织学、甲状腺超声检查及抗甲状腺球蛋白抗体阳性确诊的。我们采用静脉注射甲泼尼龙冲击治疗，随后口服泼尼松龙40mg/天。患者肾病综合征完全缓解，类固醇逐渐减量且无复发。
