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缓解52年后复发的微小病变型肾病综合征:一例报告

Minimal Change Nephrotic Syndrome Relapse after 52 Years of Remission: A Case Report.

作者信息

Yamabe Hideaki, Kaizuka Mitsuaki, Tsunoda Satoru, Shimada Michiko

机构信息

EST Clinic, Hirosaki, Japan.

Department of Nephrology, Hirosaki University Hospital, Hirosaki, Japan.

出版信息

Case Rep Nephrol Dial. 2018 Aug 31;8(2):178-181. doi: 10.1159/000492614. eCollection 2018 May-Aug.

Abstract

Minimal change nephrotic syndrome (MCNS) is the most common cause of nephrotic syndrome in children and can also present in adults. Corticosteroids generally induce remission of MCNS, and relapses are common after reduction or discontinuation of corticosteroids. We experienced a rare case of steroid-sensitive MCNS where the patient relapsed after 52 years of remission. The patient was a 61-year-old Japanese male who visited our clinic for an edema of the lower extremities which had already persisted for a few days. Laboratory testing showed massive urinary protein and low serum total protein and albumin levels. Therefore, he was diagnosed with nephrotic syndrome. He had a history of nephrotic syndrome that initially developed when he was 5 years old. Although corticosteroids reduced the urinary protein level, frequent relapses occurred when their doses were reduced, or when they were discontinued. He had previously experienced a relapse when he was 9 years old. For his current condition, treatment with corticosteroids and diuretics for 1 week reduced his edema and proteinuria. We suspected that this is a case of MCNS and that the present event is a relapse. Thus, we concluded that this is a very rare case of steroid-sensitive nephrotic syndrome that relapsed after 52 years of remission.

摘要

微小病变型肾病综合征(MCNS)是儿童肾病综合征最常见的病因,在成人中也可出现。皮质类固醇通常可诱导MCNS缓解,在皮质类固醇减量或停药后复发很常见。我们遇到了一例罕见的类固醇敏感性MCNS病例,该患者在缓解52年后复发。患者为一名61岁的日本男性,因下肢水肿已持续数天前来我院就诊。实验室检查显示大量蛋白尿以及血清总蛋白和白蛋白水平降低。因此,他被诊断为肾病综合征。他有肾病综合征病史,最初在5岁时发病。尽管皮质类固醇降低了尿蛋白水平,但在剂量减少或停药时频繁复发。他9岁时曾复发过一次。针对他目前的病情,使用皮质类固醇和利尿剂治疗1周后,水肿和蛋白尿减轻。我们怀疑这是一例MCNS病例,此次事件为复发。因此,我们得出结论,这是一例非常罕见的类固醇敏感性肾病综合征,在缓解52年后复发。

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