Sato Fumiya, Nakayama Shingo, Hirose Takuo, Endo Akari, Kasakura Yu, Kanomata Yoshitaka, Kamada Ayaka, Oba-Yabana Ikuko, Kimura Tomoyoshi, Yumura Wako, Mori Takefumi
Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, 983-8536, Japan.
Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
CEN Case Rep. 2025 Jun;14(3):455-460. doi: 10.1007/s13730-025-00986-3. Epub 2025 Mar 23.
Minimal change disease (MCD) is a common cause of idiopathic nephrotic syndrome (NS). MCD patients are complicated by acute kidney injury (AKI). Gastrointestinal disorders also occur during the course of NS; however, acute appendicitis after the development of NS has not been reported previously in patients with MCD. We report the case of a 54-year-old Japanese man with MCD who was diagnosed with acute appendicitis after developing NS. The patient visited a nearby medical clinic with abdominal distension, decreased urine volume, and edema of the face and lower limbs. As the symptoms did not improve and he developed abdominal pain, he was referred to the Division of Gastroenterology at our hospital. Hypoalbuminemia and proteinuria were detected, and he was introduced to our division and admitted for the evaluation and treatment of NS. After admission, right lower quadrant abdominal pain and rebound tenderness occurred, and an enlarged appendix and increased fat tissue density around the appendix were observed on abdominal and pelvic computed tomography. The patient underwent laparoscopic appendectomy for suspected acute perforated appendicitis and peritonitis. Although the patient required temporary hemodialysis due to oliguric AKI, the renal function and proteinuria improved with steroid therapy. We performed a renal biopsy, which revealed MCD with acute tubular injury. Since severe gastrointestinal disorders can occur in patients with MCD, these patients should be followed-up with carefully for acute abdominal pain. The prompt management of gastrointestinal disorders is important when acute abdominal pain occurs in patients with MCD.
微小病变肾病（MCD）是特发性肾病综合征（NS）的常见病因。MCD患者常并发急性肾损伤（AKI）。NS病程中也会出现胃肠道疾病；然而，此前尚未有MCD患者在NS发病后发生急性阑尾炎的报道。我们报告一例54岁日本男性MCD患者，其在NS发病后被诊断为急性阑尾炎。该患者因腹胀、尿量减少以及面部和下肢水肿前往附近诊所就诊。由于症状未改善且出现腹痛，遂转诊至我院胃肠病科。检测发现低蛋白血症和蛋白尿，随后他被转至我科，因NS入院接受评估和治疗。入院后，患者出现右下腹疼痛和反跳痛，腹部及盆腔计算机断层扫描显示阑尾肿大且阑尾周围脂肪组织密度增加。患者因疑似急性穿孔性阑尾炎和腹膜炎接受了腹腔镜阑尾切除术。尽管患者因少尿性AKI需要临时血液透析，但经类固醇治疗后肾功能和蛋白尿均有所改善。我们进行了肾活检，结果显示为伴有急性肾小管损伤的MCD。由于MCD患者可能会出现严重的胃肠道疾病，因此应对这些患者密切随访以观察是否出现急性腹痛。当MCD患者出现急性腹痛时，及时处理胃肠道疾病非常重要。
