摘要
目的本文报道1例民间土法治疗关节炎致皮肤烫伤溃烂结痂愈合,后继发IgA为主型感染相关性肾小球肾炎(IgA-IRGN)伴草酸盐沉积患者,观察其临床病理特点,探讨心、肾、关节病变之间的相关关系。方法患者入院后完善心脏超声、膝关节MRI,行肾穿刺活检及关节腔内穿刺液培养,观察其临床病理特点及治疗后转归。结果经过抗感染、降尿蛋白、改善心功能等治疗后病情好转。结论IgA-IRGN多见于2型糖尿病和免疫力低下的老年人群,该病例无上述基础疾病,肾病综合征表现合并急性肾损伤、骨性关节炎、重度二尖瓣关闭不全及二尖瓣脱垂,多病共存使得病情更为复杂。对于IgA-IRGN感染源隐匿时临床易误诊、漏诊,在诊治时需提高警惕。
Objective This article reports a patient who developed immunoglobulin A(IgA)-dominant infection-related glomerulonephritis(IgA-IRGN)with oxalate deposition following skin burns,ulceration,scab formation,and healing caused by folk remedies for arthritis.To observe the clinicopathological features and explore the correlation between the heart,kidney and joint lesions.Methods After admission,the patient underwent echocardiography,knee joint magnetic resonance imaging(MRI),renal biopsy,and culture of synovial fluid from the joint cavity.The clinical and pathological characteristics were observed,and the outcomes after treatment were analyzed.Results The patient's condition improved after treatment with anti-infective therapy,proteinuria reduction,and cardiac function improvement.Conclusion IgA-IRGN is commonly seen in elderly individuals with type 2 diabetes and immunodeficiency.However,this case did not involve these underlying conditions.The patient presented with nephrotic syndrome,acute kidney injury,osteoarthritis,severe mitral regurgitation,and mitral valve prolapse.The condition is further complicated by the coexistence of multiple diseases.When the infection source of IgA-IRGN is occult,clinical misdiagnosis and missed diagnosis are common.Therefore,increased vigilance is needed during diagnosis and treatment.
作者
赵慧
张鹏伟
张健
黄文辉
李小丽
马志刚
金芳
田利民
Zhao Hui;Zhang Pengwei;Zhang Jian;Huang Wenhui;Li Xiaoli;Ma Zhigang;Jin Fang;Tian Limin(College of Integrated Traditional Chinese and Western Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Cardiology,the Second People's Hospital of Dingxi City,Dingxi 743000,China;Department of Nephrology,Gansu Provincial Hospital,Lanzhou 730000,China;Party Committee Office,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Nephrology,Longgang District People's Hospital of Shenzhen,the Second Affiliated Hospital,School of Medicine,the Chinese University of Hong Kong-Shenzhen,Shenzhen 518000,China;Department of Endocrinology,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610000,China)
出处
《临床荟萃》
2025年第2期162-167,共6页
Clinical Focus
基金
甘肃省自然科学基金——贝利木单抗治疗狼疮性肾炎过程中B细胞激活因子(BAFF)水平变化与疾病活动度、预后评估的相关临床研究(22JR11RA265)
甘肃省自然科学基金——KM55单克隆抗体在原发性IgA肾病患者中的临床意义(21JR7RA625)
甘肃省人民医院院内科研基金——膜性肾病患者B细胞激活因子(BAFF)水平与疾病活动度、预后评估及复发的相关性研究(22GSSYB-12)。
