Tamai O, Hori Y, Kouno K, Egami J, Oohara A, Matsuoka H, Majima K, Nishida H, Higuchi E, Morimatsu M
Third Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Nihon Jinzo Gakkai Shi. 1994 Jun;36(6):769-73.
A 68-year-old patient visited our hospital, because of progressive renal failure. Laboratory data were serum creatinine 13.3 mg/dl, BUN 74.3 mg/dl, AGBMA 134U, MPO-ANCA 37% and CIC 1.6 g/dl. Hemodialysis was performed on admission and renal biopsy was conducted. Though the histological findings showed fibrocellular crescents and global sclerosis in many glomeruli, renal function was gradually ameliorated by administration of prednisolone (40 mg/day) and cyclophosphamide (50 mg/day). After 3 weeks of therapy, hemodialysis was withdrawn temporarily. Because of the complication of pneumocystis carini, prednisolone and cyclophosphamide were discontinued, and maintenance hemodialysis was resumed. In spite of progressed histological findings, hemodialysis was withdrawn at least temporarily through the use of pharmacological therapy. Thus, the presence of ANCA may indicate a relatively good prognosis of AGBMA nephritis.
一名68岁的患者因进行性肾衰竭前来我院就诊。实验室检查数据为：血清肌酐13.3mg/dl、血尿素氮74.3mg/dl、抗肾小球基底膜抗体（AGBMA）134U、髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）37%以及循环免疫复合物（CIC）1.6g/dl。入院时即进行了血液透析并实施了肾活检。尽管组织学检查结果显示许多肾小球存在纤维细胞性新月体和球性硬化，但通过给予泼尼松龙（40mg/天）和环磷酰胺（50mg/天），肾功能逐渐得到改善。治疗3周后，暂时停止了血液透析。由于并发卡氏肺孢子虫感染，停用了泼尼松龙和环磷酰胺，并恢复了维持性血液透析。尽管组织学检查结果有所进展，但通过药物治疗至少暂时停止了血液透析。因此，抗中性粒细胞胞浆抗体（ANCA）的存在可能提示抗肾小球基底膜抗体（AGBMA）肾炎的预后相对较好。
