Fujigaki Yoshihide, Morimoto Chikayuki, Iino Risa, Taniguchi Kei, Kawamorita Yosuke, Asakawa Shinichiro, Toyoki Daigo, Miyano Shinako, Fujii Wataru, Ota Tatsuru, Shibata Shigeru, Uchida Shunya
Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Central Laboratory, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Case Rep Nephrol. 2017;2017:7143649. doi: 10.1155/2017/7143649. Epub 2017 Oct 11.
A 26-year-old man highly suspected of having antiglomerular basement membrane (GBM) disease was treated with corticosteroid pulse therapy 9 days after initial infection-like symptoms with high procalcitonin value. The patient required hemodialysis the next day of the treatment due to oliguria. In addition to corticosteroid therapy, plasmapheresis was introduced and the patient could discontinue hemodialysis 43 days after the treatment. Kidney biopsy after initiation of hemodialysis confirmed anti-GBM disease with 86.3% crescent formation. Physician should keep in mind that active anti-GBM disease shows even high procalcitonin value in the absence of infection. To pursue recovery of renal function, the challenge of the immediate and persistent treatment with high-dose corticosteroids plus plasmapheresis for highly suspected anti-GBM disease is vitally important despite the presence of reported predictors for dialysis-dependence including oliguria and requiring hemodialysis at presentation.
一名高度怀疑患有抗肾小球基底膜（GBM）疾病的26岁男性，在初次出现类似感染症状且降钙素原值升高9天后接受了糖皮质激素冲击治疗。治疗次日，患者因少尿需要进行血液透析。除糖皮质激素治疗外，还进行了血浆置换，治疗43天后患者可停止血液透析。血液透析开始后的肾活检证实为抗GBM疾病，新月体形成率为86.3%。医生应牢记，在无感染的情况下，活动性抗GBM疾病的降钙素原值也会升高。为了促进肾功能恢复，对于高度怀疑的抗GBM疾病，立即且持续地使用大剂量糖皮质激素加血浆置换进行治疗至关重要，尽管存在如少尿和就诊时需要血液透析等已报道的依赖透析的预测因素。
