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肺出血肾炎综合征与肾活检后出血:一例报告

Goodpasture syndrome and hemorrhage after renal biopsy: A case report.

作者信息

Li Wei-Long, Wang Xi, Zhang Shu-Yuan, Xu Zi-Gan, Zhang Ying-Wei, Wei Xing, Li Chun-Di, Zeng Ping, Luan Shao-Dong

机构信息

Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China.

出版信息

World J Clin Cases. 2020 Jan 26;8(2):404-409. doi: 10.12998/wjcc.v8.i2.404.

Abstract

BACKGROUND

Goodpasture syndrome (GS) is a rare disease, the morbidity of which is estimated to be 0.5-0.8 per million per year. Hemorrhage is the most serious complication in renal biopsy. Despite the fact that both GS and hemorrhage after renal biopsy are rare, it has not been reported that they are likely to occur in the same patient.

CASE SUMMARY

A 30-year-old man with diffuse pulmonary hemorrhage and rapid progressive renal function caused by anti-glomerular basement membrane disease presented atypical symptoms without hemoptysis, accompanied by life-threatening hypoxemia. Plasmapheresis was performed, and glucocorticoids and cyclophosphamide were administered. The patient started to show signs of improvement. Percutaneous renal biopsy is an appropriate diagnostic measure that is commonly safe, but this patient experienced hemorrhage after operation, thus necessitating embolization of the renal artery to stop the bleeding. The patient's condition was improved, and the serum anti-glomerular basement membrane antibody level was 106 AU/mL (normal range: < 24 AU/mL) and slowly decreased. His discharge medications were oral daily prednisone (30 mg) and continued maintenance hemodialysis.

CONCLUSION

GS is a rare organ-specific autoimmune disease that is invariably ubiquitous in the lung and kidney areas. Renal biopsy is the appropriate procedure for the treatment of GS disease, although it is an invasive measure.

摘要

背景

肺出血肾炎综合征(GS)是一种罕见疾病,其发病率估计为每年百万分之0.5 - 0.8。出血是肾活检中最严重的并发症。尽管GS和肾活检后出血均罕见,但尚未有它们可能在同一患者中发生的报道。

病例摘要

一名30岁男性因抗肾小球基底膜病导致弥漫性肺出血和快速进行性肾功能损害,出现无咯血的非典型症状,并伴有危及生命的低氧血症。进行了血浆置换,并给予糖皮质激素和环磷酰胺治疗。患者开始出现好转迹象。经皮肾活检是一种常用的安全诊断措施,但该患者术后发生出血,因此需要进行肾动脉栓塞以止血。患者病情好转,血清抗肾小球基底膜抗体水平为106 AU/mL(正常范围:< 24 AU/mL)且缓慢下降。其出院用药为每日口服泼尼松(30 mg)并继续维持性血液透析。

结论

GS是一种罕见的器官特异性自身免疫性疾病,在肺和肾区域普遍存在。肾活检是治疗GS疾病的合适方法,尽管它是一种侵入性措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3c93/7000945/cb934f0a6c2c/WJCC-8-404-g001.jpg

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