一例特发性结节性肾小球硬化症经肾素-血管紧张素-醛固酮系统强化阻断治疗后成功缓解。
A case of idiopathic nodular glomerulosclerosis successfully treated by intensive blockade of the renin-angiotensin-aldosterone system.
机构信息
Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Department of Pediatrics, Child Health Research Center, University of Virginia School of Medicine, 409 Lane Road, MR4 Building, Room 2001, Charlottesville, VA, 22908, USA.
出版信息
CEN Case Rep. 2023 Aug;12(3):311-317. doi: 10.1007/s13730-022-00766-3. Epub 2022 Dec 27.
Idiopathic nodular glomerulosclerosis has a poor renal prognosis and is characterized by diffuse nodular glomerulosclerotic lesions in the absence of diabetic mellitus. Here, we report the case of a 69-year-old woman with no smoking history who developed renal dysfunction and proteinuria in the absence of overt diabetes or obesity. A biopsy specimen showed nodular mesangial sclerosis with arteriolar hyalinosis and severe large-vessel arteriosclerosis, leading to a diagnosis of idiopathic nodular glomerulosclerosis. Addition of esaxerenone to her existing renin-angiotensin-aldosterone inhibitor therapy led to a rapid decrease in the proteinuria levels and the maintenance of renal function without any complications for more than a year. The results suggest that intensive renin-angiotensin-aldosterone blockade might be an effective treatment for idiopathic nodular glomerulosclerosis.
特发性结节性肾小球硬化症的肾脏预后较差，其特征为在无糖尿病的情况下出现弥漫性结节性肾小球硬化病变。在这里，我们报告了一例 69 岁女性病例，该患者无吸烟史，在无显性糖尿病或肥胖的情况下出现肾功能障碍和蛋白尿。活检标本显示结节性系膜硬化伴小动脉玻璃样变性和严重的大动脉粥样硬化，导致特发性结节性肾小球硬化症的诊断。在她现有的肾素-血管紧张素-醛固酮抑制剂治疗基础上添加 esaxerenone 治疗，使蛋白尿水平迅速下降，肾功能维持在 1 年以上，且无任何并发症。结果表明，强化肾素-血管紧张素-醛固酮阻断可能是特发性结节性肾小球硬化症的有效治疗方法。
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