Cevallos R, Guillevin L, Jarrousse B, Godeau B, Makdassi R, Lambrey G, Barrier J
Service de Médecine Interne, Université Paris-Nord, Bobigny.
Ann Med Interne (Paris). 1993;144(5):311-3.
Rapidly progressive glomerulonephritis (RPGN) is rarely associated with macroscopic polyarteritis nodosa (PAN), as seen in this series of 7 out of 235 patients. The clinical symptoms of PAN were as follows: myalgias 6; fever 1; arthralgias and mononeuropathy multiplex 5; cutaneous vasculitis 3; arterial hypertension 4, 3 of which were malignant. The mean proteinuria was 2.7 g/24 h; creatininemia 458 microM/l; microscopic hematuria was present in 4 of the 7 patients; only 1 patient was anuric. Markers of hepatitis B virus were absent in all cases. Arteriography revealed microaneurysms and renal infarcts in 6 patients and distal arterial stenosis in one. Renal biopsies from all 7 patients demonstrated extracapillary glomerulonephritis, which was associated with tubulointerstitial fibrosis in one. Necrotizing vasculitis lesions were associated in 5 cases. Immunofluorescence was positive in 5 cases. The association of RPGN and PAN exists and may be underestimated due to the lack of systematic angiographic examinations during RPGN and renal biopsies in PAN patients with renal involvement.
快速进展性肾小球肾炎（RPGN）很少与结节性多动脉炎（PAN）相关，在这组235例患者中有7例出现这种情况。PAN的临床症状如下：肌痛6例；发热1例；关节痛和多发性单神经病5例；皮肤血管炎3例；动脉高血压4例，其中3例为恶性高血压。平均蛋白尿为2.7g/24小时；肌酐血症为458μmol/L；7例患者中有4例出现镜下血尿；仅1例患者无尿。所有病例均未检测到乙肝病毒标志物。血管造影显示6例患者有微动脉瘤和肾梗死，1例有远端动脉狭窄。所有7例患者的肾活检均显示为毛细血管外肾小球肾炎，其中1例伴有肾小管间质纤维化。5例伴有坏死性血管炎病变。免疫荧光检查5例呈阳性。RPGN与PAN之间存在关联，由于在RPGN期间缺乏系统性血管造影检查以及PAN患者出现肾脏受累时缺乏肾活检，这种关联可能被低估。
