结肠管状腺瘤合并膜性肾病的临床及病理分析

Clinical and Pathological Character of Membranous Nephropathy Combined with Colon Tubular Adenoma

【目的】总结结肠管状腺瘤合并膜性肾病的临床及病理学特点,探讨其治疗方案。【方法】分析8例结肠管状腺瘤合并膜性肾病患者的临床表现,发病时的实验室检查结果,及应用甲泼尼龙联合环磷酰胺和小剂量激素联合环孢素A治疗后尿蛋白及肾功能变化情况。【结果】8例临床表现为肾病综合征,同时结肠镜检查合并结肠管状腺瘤,均有血尿表现,50%表现高血压。6例采用甲泼尼龙联合环磷酰胺,2例应用小剂量激素联和环孢素A治疗,其中完全缓解2例,部分缓解4例,无效2例。6例肾功能稳定。【结论】膜性肾病可继发于结肠管状腺瘤,肾病综合征合并血尿患者,应常规行结肠镜检查,避免漏诊,甲泼尼龙联合环磷酰胺治疗方案可作为首选。

[ Objective ] The clinical and pathological character of membranous nephropathy combined with colon tubular adenoma were analyzed, and the treatment were investigated. [ Methods ] Data of clinical and pathological of 8 patients with membranous nephropathy combined with colon tubular adenoma were collected. After different drug therapy, change of urinary protein and renal function were showed during 12 months follow up. [Results] All patients were in line with nephritic syndrome, and also have hematuria. The histology of them was membranous nephropathy. Colon tubular adenomas were diagnosis by the colonoscopy biopsy. Hypertension could be found in fifty percent of them. Six of them were take the methylprednisolone combined with cyclophosphamide, the other two were treated with low dose prednisolone and cyclosporine A. Two of all 8 patients were completely remission and 4 patients were partly remission, the other two were invalid. The renal functions of 6 patients were keeping stabilized. [Conclusion] Membranous nephropathy could be secondary to colon tubular adenoma. If patients in line with nephritic syndrome also have hematuria, the colonoscopy should be taken to avoid missing diagnosis. The treatment of methylprednisolone combined with cyclophosphamide was recommended.