Medicine, The University of Auckland, Auckland, New Zealand
Renal Medicine, Middlemore Hospital, Auckland, New Zealand.
BMJ Case Rep. 2024 Feb 29;17(2):e257762. doi: 10.1136/bcr-2023-257762.
Membranous nephropathy has been associated with demyelinating polyneuropathies and antiglomerular membrane disease; however, an association with vasculitic neuropathy has not been described. This case describes a patient with biopsy-proven idiopathic membranous nephropathy and synchronous mononeuritis multiplex secondary to idiopathic small vessel vasculitis, who presented with lower limb microvascular ischaemia, peripheral neuropathy and active urinary sediment. Her extensive non-invasive screening for immunological disease and radiological investigations for occult malignancy were unremarkable. The patient received intravenous methylprednisolone and intravenous rituximab induction therapy resulting in complete remission of both the idiopathic membranous nephropathy and small vessel vasculitis at 7 months post treatment.
膜性肾病与脱髓鞘性多发性神经病和抗肾小球膜病有关；然而，尚未描述与血管炎性神经病有关。本病例描述了一名活检证实为特发性膜性肾病的患者，同时发生多发性单神经病，继发于特发性小血管血管炎，表现为下肢微血管缺血、周围神经病和活动性尿沉渣。她广泛的非侵入性免疫性疾病筛查和隐匿性恶性肿瘤的影像学检查均无异常。该患者接受了静脉甲基强的松龙和静脉利妥昔单抗诱导治疗，治疗后 7 个月，特发性膜性肾病和小血管血管炎完全缓解。
