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水痘后膜增生性肾小球肾炎伴大量蛋白尿的罕见病例。

Rare case of post-varicella membranoproliferative glomerulonephritis presenting with massive proteinuria.

作者信息

Majumdar Avirup, Atam Virendra, Mishra Mayank

机构信息

Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India

Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.

出版信息

BMJ Case Rep. 2020 Mar 12;13(3):e233084. doi: 10.1136/bcr-2019-233084.

Abstract

Chicken pox caused by varicella zoster virus is usually a self-limiting disease causing rare life-threatening complications. Involvement of the kidneys is infrequent during the course of the illness. Literature shows rare reports of acute glomerulonephritis following varicella infection. We report a case of 16-year-old boy presenting with anasarca with characteristic healed rashes of chicken pox. His urinalysis revealed a 'massive' nephrotic range proteinuria (16 g/24 hours), gross hematuria and pyuria. A percutaneous renal biopsy showed membranoproliferative glomerulonephritis. Most cases of post-varicella glomerulonephritis have been described in children, massive proteinuria of this range in an immunocompetent adolescent, being an extremely rare entity. Acute proliferative glomerulonephritis in such cases is usually an immune complex hypocomplementaemic glomerulonephritis in response to the zoster infection. Proteinuria in most patients is benign and self-limiting with few fatal reports of crescentic glomerulonephritis progressing to acute renal failure.

摘要

水痘带状疱疹病毒引起的水痘通常是一种自限性疾病,很少会引发危及生命的并发症。在疾病过程中,肾脏受累并不常见。文献显示,水痘感染后急性肾小球肾炎的报道很少。我们报告一例16岁男孩,表现为全身性水肿,伴有水痘特征性的愈合皮疹。他的尿液分析显示“大量”肾病范围蛋白尿(16克/24小时)、肉眼血尿和脓尿。经皮肾活检显示为膜增生性肾小球肾炎。大多数水痘后肾小球肾炎病例见于儿童,在免疫功能正常的青少年中出现如此大量的蛋白尿是极为罕见的情况。此类病例中的急性增生性肾小球肾炎通常是对带状疱疹感染的免疫复合物低补体血症性肾小球肾炎。大多数患者的蛋白尿是良性且自限性的,新月体性肾小球肾炎进展为急性肾衰竭的致命报道很少。

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