Kamijo Natsumi, Mii Akiko, Aratani Sae, Kashiwagi Tetsuya, Oda Takashi, Shimizu Akira, Sakai Yukinao
Department of Nephrology, Nippon Medical School, Japan.
Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Japan.
Intern Med. 2022 Oct 1;61(19):2917-2923. doi: 10.2169/internalmedicine.8690-21. Epub 2022 Mar 12.
A 44-year-old woman was admitted due to gross hematuria and progressive renal dysfunction. Poststreptococcal acute glomerulonephritis (PSAGN) was suspected due to her elevated anti-streptolysin O and anti-streptokinase titers and hypocomplementemia. A renal biopsy showed crescent formation and endocapillary hypercellularity with neutrophil infiltrate. An immunofluorescence analysis showed granular immunoglobulin G and C3 deposition, suggesting immune-complex-type glomerulonephritis. However, myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA) was positive, and peritubular capillaritis was observed. Furthermore, citrullinated histone H3-positive neutrophils were detected as markers for neutrophil extracellular trap formation. Therefore, she was diagnosed with ANCA-associated vasculitis superimposed on PSAGN that was the main contributor to her progressive renal injury.
一名44岁女性因肉眼血尿和进行性肾功能不全入院。由于其抗链球菌溶血素O和抗链激酶滴度升高以及补体血症，怀疑为链球菌感染后急性肾小球肾炎（PSAGN）。肾活检显示有新月体形成和毛细血管内细胞增多伴中性粒细胞浸润。免疫荧光分析显示颗粒状免疫球蛋白G和C3沉积，提示免疫复合物型肾小球肾炎。然而，髓过氧化物酶抗中性粒细胞胞浆抗体（ANCA）呈阳性，并观察到肾小管周围毛细血管炎。此外，检测到瓜氨酸化组蛋白H3阳性中性粒细胞作为中性粒细胞胞外诱捕网形成的标志物。因此，她被诊断为ANCA相关性血管炎叠加在PSAGN上，这是导致其进行性肾损伤的主要原因。
