Sugiyama T, Sueishi M, Matsumura R, Tomioka H, Akikusa B
Department of Internal Medicine, Shimoshizu National Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1997 May;39(4):426-30.
A 45-year-old woman with rheumatoid arthritis(RA) who developed nephrotic syndrome and acute renal failure was reported. She first noticed polyarthritis in June 1990, and was diagnosed as RA. Since her RA was not controlled with nonsteroidal anti-inflammatory drugs (NSAID), she started taking prednisolone 10 mg daily and received 100 mg of D-penicillamine from October 1990 with improvement of the RA. In March 1991, she noticed edema of the face and legs, at which time massive proteinuria and hematuria were first noted. Because of her nephrosis, she was referred to our hospital for further evaluation. Laboratory investigations revealed 24-hour urine proteinuria of 37 g, serum creatinine, 2.7 mg/dl, blood urea nitrogen, 43.5 mg/dl, total protein, 4.1 g/dl, albumin, 1.5 mg/dl, and total cholesterol, 600 mg/dl. The rheumatoid factor and anti-nuclear antibody were positive. Renal biopsy showed focal segmental glomerulosclerosis (FSGS). Her nephrotic syndrome and renal dysfunction recovered after the administration of prednisolone at 60 mg/day. The possible pathogenesis of FSGS in patients with RA was discussed.
报告了一名45岁患有类风湿关节炎（RA）并发展为肾病综合征和急性肾衰竭的女性。她于1990年6月首次出现多关节炎，被诊断为RA。由于其RA未被非甾体抗炎药（NSAID）控制，她从1990年10月开始每日服用10 mg泼尼松龙，并接受100 mg青霉胺治疗，RA症状有所改善。1991年3月，她注意到面部和腿部水肿，此时首次发现大量蛋白尿和血尿。由于她患有肾病，被转诊至我院作进一步评估。实验室检查显示24小时尿蛋白为37 g，血清肌酐2.7 mg/dl，血尿素氮43.5 mg/dl，总蛋白4.1 g/dl，白蛋白1.5 mg/dl，总胆固醇600 mg/dl。类风湿因子和抗核抗体呈阳性。肾活检显示局灶节段性肾小球硬化（FSGS）。在每天服用60 mg泼尼松龙后，她的肾病综合征和肾功能障碍得以恢复。文中讨论了RA患者发生FSGS的可能发病机制。
