摘要
目的通过分析1例结节病肾损害患者的临床资料并结合文献复习,提高临床医师对于结节病肾损害的认识和诊治水平。方法报告1例结节病肾损害,分析其病史、临床表现、病理特征及诊治过程,复习国内外相关文献,总结结节病肾损害的诊治经验。结果患者为女性,39岁,以"咳嗽、发热"为主要首发表现,1月余后出现"蛋白尿、镜下血尿"等肾损害表现。胸部CT示纵隔及双侧肺门淋巴结肿大,气道黏膜及肾穿刺活检均发现非干酪坏死性肉芽肿,确诊为结节病肾损害。给予糖皮质激素联合环磷酰胺治疗,取得较好效果,尿蛋白、尿钙降至正常,镜下血尿消失,胸部CT示纵隔及肺门淋巴结较前明显缩小。结论结节病肾损害临床较少见,临床表现不典型,早期诊断、及时治疗,可取得较好效果。
Objective To improve the ability of clinicians in the recognition,diagnosis and treatment of sarcoidosis with renal damage through analyzing the clinical data of one case of sarcoidosis with renal damage and literature review.Methods One case of sarcoidosis with renal damage was reported.The case history,clinical manifestations,pathological features,diagnosis and treatment of the patient were analyzed,and the related literature published domestically and abroad was reviewed to summarize the experiences in diagnosis and treatment of the disease.Results The patient was a 39 years old woman.The primary main clinical manifestations were cough and fever.Renal damage manifesting proteinuria and microscopic hematuria appeared one month later,and chest CT showed mediastinum and bilateral hilar lymphadenectasis.Renal and tracheal mucosa biopsy revealed noncaseating necrotized granuloma,so the diagnosis of sarcoidosis with renal damage was confirmed.Administration of glucocorticoid combined with cyclophosphamide achieved good therapeutic effect： hypercalciuria and proteinuria that lymph nodes in were abated with urinary calcium and protein returned to normal level,and microscopic hematuria disappeared.Chest CT showed mediastinum and hilum on both sides reduced significantly in size compared with those before the treatment.Conclusion Sarcoidosis with renal damage is a rare disease with atypical clinical manifestations.Early diagnosis and timely treatment may achieve good effects.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2013年第9期767-771,共5页
Medical Journal of Chinese People's Liberation Army
关键词
结节病
肾功能不全
急性
肉芽肿
糖皮质激素
sarcoidosis
renal insufficiency
acute
granuloma
glucocorticoids
