成功治疗并存的膜性肾病和免疫性血小板减少症根除胃幽门螺杆菌感染:一例报告。

Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report.

机构信息

Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan.

Hokkaido Renal Pathology Center, Sapporo, Japan.

出版信息

CEN Case Rep. 2024 Apr;13(2):98-103. doi: 10.1007/s13730-023-00805-7. Epub 2023 Jul 8.

Abstract

Membranous nephropathy (MN) is a common cause of nephrotic syndrome in middle-aged and older adults. MN etiology is mainly primary or idiopathic; however, it may also be secondary to infections, drugs, neoplasms, and autoimmune diseases. We present the case of a 52-year-old Japanese man with coexisting nephrotic MN and immune thrombocytopenic purpura (ITP). Renal biopsy revealed glomerular basement membrane thickening with immunoglobulin (Ig) G and complement component 3 deposition. Glomerular IgG subclass analysis revealed predominant IgG4 deposition with weak IgG1 and IgG2 deposition. IgG3 and phospholipase A2 receptor deposits were negative. Upper endoscopy revealed no ulcers, but histological examination demonstrated Helicobacter pylori infection in the gastric mucosa with elevated IgG antibodies. After gastric Helicobacter pylori eradication, the nephrotic-range proteinuria and thrombocytopenia of the patient were markedly improved without initiation of immunosuppressive treatment. Therefore, clinicians should consider the possibility of Helicobacter pylori infection in patients with coexisting MN and ITP. Further studies are required to demonstrate the associated pathophysiological aspects.

摘要

膜性肾病(MN)是中老年人肾病综合征的常见病因。MN 的病因主要为原发性或特发性;然而,它也可能继发于感染、药物、肿瘤和自身免疫性疾病。我们报告了一例同时患有肾病性 MN 和免疫性血小板减少性紫癜(ITP)的 52 岁日本男性病例。肾活检显示肾小球基底膜增厚,伴有免疫球蛋白(Ig)G 和补体成分 3 沉积。肾小球 IgG 亚类分析显示 IgG4 沉积为主,伴有弱 IgG1 和 IgG2 沉积。IgG3 和磷脂酶 A2 受体沉积阴性。上消化道内镜检查未见溃疡,但组织学检查显示胃黏膜存在幽门螺杆菌感染,且 IgG 抗体升高。在胃幽门螺杆菌根除后,患者的肾病范围蛋白尿和血小板减少症明显改善,而无需开始免疫抑制治疗。因此,临床医生应考虑同时患有 MN 和 ITP 的患者存在幽门螺杆菌感染的可能性。需要进一步研究来阐明相关的病理生理方面。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d395/10982251/33ca56325d09/13730_2023_805_Fig1_HTML.jpg

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