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免疫性血小板减少性紫癜治疗期间观察到的伴有满堂亮模式的免疫复合物介导的系膜增生性肾小球肾炎。

Immune-Complex Mediated Mesangial Proliferative Glomerulonephritis with Full-House Pattern Observed During Treatment of Immune Thrombocytopenic Purpura.

作者信息

Ueki Ai, Fukunaga Tsugumi, Goto Hiroyasu, Minakuchi Hitoshi, Oshima Naoki

机构信息

Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Japan.

出版信息

Clin Med Insights Case Rep. 2024 Dec 24;17:11795476241307123. doi: 10.1177/11795476241307123. eCollection 2024.

Abstract

This study reports a rare case of immune-complex mediated mesangial proliferative glomerulonephritis (ICGN) with a full-house pattern in a 56-year-old Japanese man, observed during the treatment of immune thrombocytopenic purpura (ITP). Because of persistent complement deficiency and worsening of kidney function, he was treated with prednisolone, and his urinary findings improved markedly. However, as the complement titers were still low, mycophenolate mofetil was also prescribed, which normalized complement levels. Production of anti-platelet antibodies is considered to be involved in the etiology of ITP. Although little is known about the mechanism by which ITP causes glomerulonephritis, including ICGN, glomerular deposition of circulating immune complexes synthesized by antiplatelet antibodies may be involved. This case shows full-house nephropathy, suggesting the involvement of immune complexes, which in turn, suggested an association between ITP and glomerulonephritis.

摘要

本研究报告了一例罕见的免疫复合物介导的系膜增生性肾小球肾炎(ICGN),呈现满堂亮模式,患者为一名56岁的日本男性,在免疫性血小板减少性紫癜(ITP)治疗期间被观察到。由于持续的补体缺乏和肾功能恶化,他接受了泼尼松龙治疗,尿液检查结果明显改善。然而,由于补体滴度仍然很低,也给予了霉酚酸酯治疗,补体水平恢复正常。抗血小板抗体的产生被认为与ITP的病因有关。虽然对于ITP导致肾小球肾炎(包括ICGN)的机制知之甚少,但由抗血小板抗体合成的循环免疫复合物在肾小球的沉积可能参与其中。该病例显示为满堂亮肾病,提示免疫复合物的参与,这反过来又提示了ITP与肾小球肾炎之间的关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df50/11672467/719f7548533f/10.1177_11795476241307123-fig1.jpg

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