血浆置换疗法对一名患有抗肾小球基底膜抗体性肾小球肾炎且伴有晚期肾功能不全患者的疗效

Usui Toshiaki, Kai Hirayasu, Noguchi Kazuyuki, Morito Naoki, Usui Joichi, Saito Chie, Uesugi Noriko, Nagata Michio, Yamagata Kunihiro

Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan.

Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Japan.

Intern Med. 2017 Sep 15;56(18):2475-2479. doi: 10.2169/internalmedicine.8571-16. Epub 2017 Aug 21.

Patients with anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN) have severe kidney dysfunction, leading to end-stage renal disease. The effect of plasmapheresis and immunosuppressive treatment in patients with severe glomerular changes is controversial. A 62-year-old man was admitted with rapidly progressive glomerulonephritis and diagnosed with anti-GBM GN. He required hemodialysis. All glomeruli in the kidney biopsy specimen had cellular crescents without fibrotic changes, suggesting reversible damage. He was treated with plasmapheresis until the anti-glomerular basement membrane antibodies disappeared. His kidney function recovered, and dialysis was able to be discontinued. Frequent plasmapheresis in patients with dialysis-dependent anti-GBM GN may improve the kidney prognosis.

抗肾小球基底膜抗体肾小球肾炎（抗GBM GN）患者存在严重肾功能不全，可导致终末期肾病。血浆置换和免疫抑制治疗对严重肾小球病变患者的疗效存在争议。一名62岁男性因快速进展性肾小球肾炎入院，诊断为抗GBM GN。他需要进行血液透析。肾活检标本中的所有肾小球均有细胞性新月体，无纤维化改变，提示为可逆性损伤。对他进行了血浆置换治疗，直至抗肾小球基底膜抗体消失。他的肾功能恢复，能够停止透析。对于依赖透析的抗GBM GN患者，频繁进行血浆置换可能改善肾脏预后。