Hirayama A, Kikuchi H, Hibino T, Kobayashi M, Yamaguchi N, Iitsuka T, Ngase S, Aoyagi K, Shimokama T, Koyama A, Tojo S
Kidney Center, Tsukuba Gakuen Hospital.
Nihon Jinzo Gakkai Shi. 1998 Feb;40(2):54-9.
We report here a case of severe membranoproliferative glomerulonephritis with a singular high titer of anticardiolipin antibody (aCL). A 19-year-old Japanese female was admitted to Tsukuba Gakuen Hospital after complaining of general edema for 5 months. She had no past history of thrombosis, thrombocytopenia, or spontaneous abortion. Laboratory findings revealed that she had nephrotic syndrome and moderate renal dysfunction. Immunological test showed a high titer of aCL with a high-normal limit of antinuclear antibody, negativity for anti-beta(2) glycoprotein I antibody and negativity for anti-DNA antibody. In the renal biopsy tissue, most glomeruli showed global sclerosis and the remaining glomeruli revealed membranoproliferative change with crescent formation. Steroid therapy with warfarin and dipyridamole was effective and her renal function improved gradually. This case lacked the typical symptoms of primary antiphospholipid syndrome and did not satisfy the criteria of SLE. In spite of these findings, the singular high titer of aCL with membranoproliferative glomerulonephritis characterized this case.
我们在此报告一例伴有高滴度抗心磷脂抗体(aCL)的严重膜增生性肾小球肾炎病例。一名19岁日本女性在主诉全身水肿5个月后入住筑波学园医院。她既往无血栓形成、血小板减少或自然流产史。实验室检查发现她患有肾病综合征和中度肾功能不全。免疫检查显示aCL滴度高,抗核抗体处于高正常范围,抗β2糖蛋白I抗体阴性,抗DNA抗体阴性。在肾活检组织中,大多数肾小球呈现全球硬化,其余肾小球显示伴有新月体形成的膜增生性改变。使用华法林和双嘧达莫的类固醇治疗有效,她的肾功能逐渐改善。该病例缺乏原发性抗磷脂综合征的典型症状,也不符合系统性红斑狼疮的标准。尽管如此,伴有膜增生性肾小球肾炎的高滴度aCL是该病例的特征。