Cheng Y F, Chuang F R, Chen J B, Liao S C, Lam K K, Hsu K T
Department of Medicine, Chang Gung Memorial Hospital, Kaohsiung.
Changgeng Yi Xue Za Zhi. 1998 Jun;21(2):158-64.
Susceptibility to infection is a common problem in a patient with nephrotic syndrome. The spontaneous cellulitis is not uncommon in pediatric patients with nephrotic syndrome, whereas there have been few cases reported in adults. In order to clarify the clinical course of this complication, we present 17 adult idiopathic nephrotic patients with spontaneous cellulitis.
A series of 17 adult idiopathic nephrotic patients with spontaneous cellulitis were retrospectively reviewed in Chang Gung Memorial Hospital, Kaohsiung from 1986 through 1996. We analyzed their physical conditions, clinical manifestations, and outcome. All patients received renal biopsies and had pathologic diagnoses.
The medical records of 17 patients were collected, 12 men and 5 women, with ages ranging from 16 to 63 years (mean 29.5 years). The pathologic diagnoses of renal biopsies included minimal change disease (13/17), membranous glomerulonephritis (2/17), mesangioproliferative glomerulonephritis (1/17) and focal/segmental glomerulosclerosis (1/17). All patients had generalized edematous state. The clinical presentations of these patients were variable. The mean serum albumin and daily urinary protein excretion were 1.28+/-0.64 g/dl and 8.75+/-5.16 g, respectively. The results of blood cultures were E. coli (3/17), Gram-negative bacilli (1/17), Streptococcus viridans (1/17), Streptococcus pneumoniae (1/17) and no growth (11/17). All patients responded to antibiotic treatment except one patient who died due to overwhelming sepsis.
The related factors of spontaneous cellulitis in patients with nephrotic syndrome are edematous skin, hypoalbuminemia, immunosuppressive drugs and defective immunity. Our patients had accordant conditions. The prognosis was good if diagnosis and treatment are made early.
感染易感性是肾病综合征患者的常见问题。自发性蜂窝织炎在小儿肾病综合征患者中并不少见，而在成人中报道的病例较少。为了阐明这种并发症的临床过程，我们报告了17例患有自发性蜂窝织炎的成人特发性肾病患者。
回顾性分析了1986年至1996年在高雄长庚纪念医院就诊的17例患有自发性蜂窝织炎的成人特发性肾病患者。我们分析了他们的身体状况、临床表现和结局。所有患者均接受了肾活检并获得了病理诊断。
收集了17例患者的病历，其中男性12例，女性5例，年龄在16至63岁之间（平均29.5岁）。肾活检的病理诊断包括微小病变病（13/17）、膜性肾小球肾炎（2/17）、系膜增生性肾小球肾炎（1/17）和局灶节段性肾小球硬化（1/17）。所有患者均有全身水肿状态。这些患者的临床表现各不相同。平均血清白蛋白和每日尿蛋白排泄量分别为1.28±0.64g/dl和8.75±5.16g。血培养结果为大肠杆菌（3/17）、革兰氏阴性杆菌（1/17）、草绿色链球菌（1/17）、肺炎链球菌（1/17），无生长（11/17）。除1例因严重败血症死亡外，所有患者对抗生素治疗均有反应。
肾病综合征患者自发性蜂窝织炎的相关因素为皮肤水肿、低白蛋白血症、免疫抑制药物和免疫缺陷。我们的患者符合这些情况。如果早期诊断和治疗，预后良好。
