Umekawa T, Kohri K, Yoshioka K, Iguchi M, Kurita T
Department of Urology, Kinki University School of Medicine, Osaka, Japan.
Urol Int. 1994;52(2):106-8. doi: 10.1159/000282584.
We report a case of acute renal failure occurring about 90 days after extracorporeal shock wave lithotripsy (ESWL) for a right renal stone. On left renal needle biopsy, immunofluorescence demonstrated linear fixation of IgG and C3 along the glomerular basement membrane (GBM). Serum circulating antitype IV collagen NC1 domain antibody was detected after ESWL, while it was not detected in the serum taken before ESWL. Based on these findings, the diagnose of anti-GBM antibody-mediated glomerulonephritis was made. Circulating antibodies against several GBM components (type IV collagen NC1 domain, laminin, fibronectin and heparan sulfate proteoglycan) was consistently negative in 9 randomly selected patients who underwent ESWL for renal stones. These findings suggest that the production of these autoantibodies associated with irradiation of shock waves to the kidney was not frequent, but, after ESWL, patients deserve close follow-up.
我们报告一例右肾结石体外冲击波碎石术（ESWL）后约90天发生急性肾衰竭的病例。左肾穿刺活检显示，免疫荧光法检测到IgG和C3沿肾小球基底膜（GBM）呈线性沉积。ESWL后检测到血清中循环抗IV型胶原NC1结构域抗体，而ESWL前采集的血清中未检测到该抗体。基于这些发现，诊断为抗GBM抗体介导的肾小球肾炎。在9例随机选择的接受肾结石ESWL治疗的患者中，针对几种GBM成分（IV型胶原NC1结构域、层粘连蛋白、纤连蛋白和硫酸乙酰肝素蛋白聚糖）的循环抗体始终为阴性。这些发现表明，与冲击波照射肾脏相关的这些自身抗体的产生并不常见，但ESWL后，患者值得密切随访。
