Mizuiri K, Kameyama M, Sagawa Y, Yoshioka T, Hatori T, Nanba T
Gastroenterol Jpn. 1985 Oct;20(5):470-5. doi: 10.1007/BF02774785.
A 34-year-old male presented with fulminant hepatitis A associated with acute renal failure. The patient was admitted four days after flu-like symptoms developed. Physical examination was unremarkable except for icteric sclerae. Laboratory studies showed SGOT 10719 U/l, SGPT 5780 U/l, prothrombin time 22%, BUN 25.5 mg/dl, and creatinine 2 mg/dl. Serum complements were within normal ranges, and circulating immune complexes were not detected. Anti-HAV IgM was positive. He developed hepatic coma on the fourth hospital day, and his renal function deteriorated progressively. He was treated with hemodialysis, but there was no improvement in consciousness. Although acute liver failure improved, he died on the 74th hospital day of subendocardial infarction. Autopsy examination showed acute renal tubular necrosis. The liver was enlarged and was in the residual stage of acute hepatitis without submassive necrosis. The development of fulminant hepatitis in hepatitis A has been rare, but in recent years acute renal failure in hepatitis A has been reported. Although the mechanisms responsible for renal failure in liver diseases are uncertain but could be multifactorial, immune complex-mediated nephritis and/or endotoxemia have been considered.
一名34岁男性因暴发性甲型肝炎合并急性肾衰竭入院。患者在出现流感样症状4天后入院。体格检查除巩膜黄染外无异常。实验室检查显示谷草转氨酶10719 U/l，谷丙转氨酶5780 U/l，凝血酶原时间22%，血尿素氮25.5 mg/dl，肌酐2 mg/dl。血清补体在正常范围内，未检测到循环免疫复合物。抗甲型肝炎病毒IgM阳性。患者在住院第4天出现肝昏迷，肾功能逐渐恶化。给予血液透析治疗，但意识无改善。虽然急性肝衰竭有所改善，但患者在住院第74天死于心内膜下梗死。尸检显示急性肾小管坏死。肝脏肿大，处于急性肝炎残留期，无亚大块坏死。甲型肝炎暴发性肝炎的发生较为罕见，但近年来有甲型肝炎合并急性肾衰竭的报道。虽然肝病导致肾衰竭的机制尚不确定，可能是多因素的，但免疫复合物介导的肾炎和/或内毒素血症已被考虑在内。
