Department of Nephrology, Shanxi Provincial People's Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China.
Shanxi Provincial Key Laboratory of Kidney Disease, Taiyuan, China.
Immun Inflamm Dis. 2023 Nov;11(11):e1074. doi: 10.1002/iid3.1074.
Rapidly progressive glomerulonephritis (RPGN) is clinically manifestations as a rapidly progressive renal failure and pathologically as crescentic and necrotizing lesions with infiltration of inflammatory cells in the glomeruli. Uremic encephalopathy (UE) usually develops in patients who are suffering from acute or chronic renal failure.
The purpose of this article is to provide reference for clinical diagnosis and treatment of renal disease complicated with seizures. Patients Two cases of anti-glomerular basement membrane type rapidly progressive glomerulonephritis complicated with seizures were reported.
MATERIALS & METHODS: In case 1, a 40-year-old woman was hospitalized for the treatment of nausea, anorexia, and fever. On admission, she presented with elevated serum inflammatory indicators, moderate anemia, and advanced acute kidney injury requiring hemodialysis. Her anti-glomerular basement membrane (GBM) antibody in serum and renal tissues was found to be extremely high. She was finally diagnosed with anti-GBM disease. She was treated with a combination of corticosteroid pulse therapy, oral cyclophosphamide and prednisolone, and plasma exchange, while continued to require maintenance hemodialysis for end-stage kidney disease. During treatment, she suddenly suffered blindness, seizure, and consciousness disturbance. She was diagnosed as posterior reversible leukoencephalopathy syndrome by magnetic resonance imaging (MRI). The posterior reversible leukoencephalopathy syndrome subsided quickly after control of her hypertension and reinforcement of immunosuppressive treatment. In case 2, the patient also developed epileptic symptoms on the basis of GBM disease, and was given treatment similar to that of Case 1, so that the epileptic symptoms were controlled.
Reversible posterior leukoencephalopathy syndrome, especially when accompanied by cerebral hemorrhage, may lead to irreversible and lethal neurological abnormalities, and nephrologists should, therefore, be aware of the potential risk of reversible posterior leukoencephalopathy syndrome in patients with anti-GBM disease. We can discuss the current two cases in the light of the previous literature.
急进性肾小球肾炎（RPGN）以快速进行性肾衰竭为临床表现，病理上表现为新月体和坏死性病变，伴有肾小球内炎症细胞浸润。尿毒症性脑病（UE）通常发生在患有急性或慢性肾衰竭的患者中。
本文旨在为伴有癫痫发作的肾脏疾病的临床诊断和治疗提供参考。
报告了 2 例抗肾小球基底膜型 RPGN 合并癫痫发作的病例。例 1，一名 40 岁女性因恶心、厌食和发热住院治疗。入院时，她表现出血清炎症指标升高、中度贫血和严重急性肾损伤，需要血液透析。她的血清和肾组织中的抗肾小球基底膜（GBM）抗体极高。最终诊断为抗 GBM 病。她接受了皮质类固醇脉冲治疗、口服环磷酰胺和泼尼松龙以及血浆置换的联合治疗，同时继续需要维持性血液透析治疗终末期肾病。在治疗过程中，她突然出现失明、癫痫发作和意识障碍。磁共振成像（MRI）诊断为可逆性后部白质脑病综合征。在后可逆性后部白质脑病综合征得到控制、免疫抑制治疗得到加强后，迅速缓解。例 2，患者在 GBM 病的基础上也出现了癫痫症状，给予了与例 1 相似的治疗，使癫痫症状得到了控制。
可逆性后部白质脑病综合征，尤其是伴有脑出血时，可能导致不可逆转和致命的神经异常，因此肾病学家应意识到抗 GBM 病患者发生可逆性后部白质脑病综合征的潜在风险。我们可以根据以前的文献讨论目前的两个病例。
