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一例伴妊娠的微小病变性肾病综合征。

A case of minimal change nephrotic syndrome with pregnancy.

机构信息

Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.

出版信息

CEN Case Rep. 2021 Aug;10(3):315-319. doi: 10.1007/s13730-020-00568-5. Epub 2021 Jan 6.

Abstract

A 32-year-old Japanese woman at 8 weeks of gestation was admitted to our hospital for systemic edema, hypoalbuminemia, and severe proteinuria. The patient had a history of generalized alopecia and migraine. We diagnosed nephrotic syndrome, and renal biopsy revealed minimal change nephrotic syndrome (MCNS). We administered 1000 mg/day of methylprednisolone for 3 days. Oral corticosteroid therapy was followed by 40 mg of prednisolone daily. We carefully selected concomitant medication after considering organogenesis. Before and after renal biopsy, we administered heparin, antithrombin III, and immunoglobulin agents as appropriate. The patient achieved complete remission on day 8 of treatment and gave birth to a boy at 37 weeks of gestation without recurrence. MCNS during pregnancy is rare, and there is no established treatment. In conclusion, we present a case of a pregnant woman with MCNS during organogenesis. Early treatment initiation can provide a good prognosis for both mother and child.

摘要

一位 32 岁的日本女性,妊娠 8 周时因全身水肿、低白蛋白血症和严重蛋白尿而入院。该患者有全身性脱发和偏头痛病史。我们诊断为肾病综合征,肾活检显示为微小病变性肾病综合征(MCNS)。我们给予患者甲基泼尼松龙 1000mg/天,连续治疗 3 天。随后给予患者口服皮质类固醇治疗,每日剂量为 40mg 的泼尼松。我们在考虑器官发生期的情况下,仔细选择了伴随药物。在进行肾活检前后,我们根据需要给予了肝素、抗凝血酶 III 和免疫球蛋白制剂。患者在治疗第 8 天达到完全缓解,并在 37 周妊娠时分娩了一名男婴,且未复发。妊娠期间的 MCNS 较为罕见,且目前尚无标准的治疗方法。总之,我们报告了一例器官发生期的妊娠合并 MCNS 的病例。早期治疗的启动可为母婴提供良好的预后。

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本文引用的文献

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Minimal Change Disease.微小病变性肾病。
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):332-345. doi: 10.2215/CJN.05000516. Epub 2016 Dec 9.
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Triple confusion: An interesting case of proteinuria in pregnancy.
Saudi J Kidney Dis Transpl. 2016 Sep-Oct;27(5):1029-1032. doi: 10.4103/1319-2442.190882.
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Case of alopecia universalis accompanied by minimal change nephrotic syndrome.
J Dermatol. 2015 Nov;42(11):1131-2. doi: 10.1111/1346-8138.13046. Epub 2015 Aug 24.
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Renal biopsy in the management of lupus nephritis during pregnancy.妊娠期间狼疮性肾炎管理中的肾活检
Lupus. 2015 Feb;24(2):147-54. doi: 10.1177/0961203314551812. Epub 2014 Sep 23.
10
Minimal change disease in pregnancy.妊娠期间的微小病变肾病
J Matern Fetal Neonatal Med. 2014 Aug;27(12):1282-4. doi: 10.3109/14767058.2013.852178. Epub 2013 Oct 24.

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