Department of Nephrology, Gifu Prefectural Tajimi Hospital, Japan.
Intern Med. 2022 Aug 15;61(16):2497-2502. doi: 10.2169/internalmedicine.8799-21. Epub 2022 Feb 1.
A 49-year-old woman presented with nephrotic-range proteinuria, microhematuria, and moderate renal dysfunction. Diuretic-resistant refractory ascites associated with nephrotic syndrome were observed. Based on the histopathological findings, the patient was diagnosed with proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID). Rituximab was administered due to steroid and immunosuppressive drug resistance, and partial remission was achieved after six months. Cell-free and concentrated ascites reinfusion therapy (CART) performed to treat the refractory ascites improved the ascites and anasarca. Rituximab successfully treated the PGNMID, while CART effectively treated the refractory ascites associated with nephrotic syndrome.
一位 49 岁女性因肾病范围蛋白尿、镜下血尿和中度肾功能障碍就诊。观察到利尿剂抵抗性难治性肾病综合征相关腹水。基于组织病理学发现，该患者被诊断为伴有单克隆免疫球蛋白 G 沉积的增生性肾小球肾炎（PGNMID）。由于类固醇和免疫抑制剂耐药，给予利妥昔单抗治疗，六个月后获得部分缓解。为治疗难治性腹水，进行了无细胞浓缩腹水再输注治疗（CART），腹水和水肿得到改善。利妥昔单抗成功治疗了 PGNMID，而 CART 有效治疗了与肾病综合征相关的难治性腹水。
