以慢性肾炎综合征为主要表现的Fabry病2例报道并文献复习

Fabry disease with chronic nephritis syndrome as the main manifestation and literature study:2 cases report

目的探讨以慢性肾炎综合征为主要表现的Fabry病临床表现和肾脏病理学特点。方法回顾性分析收治的以慢性肾炎综合征为主要表现的Fabry病2例,分析其临床体征及病理学特征,同时复习相关文献掌握其诊断及治疗方法。结果男女患者各1例,发病年龄分别为46岁和44岁,2例均表现为蛋白尿、血尿、高血压,而无特征性的肾外表现。光镜下显示肾小球硬化率分别为30.8%、32.1%,肾小球足细胞显著肿胀,胞浆内可见空泡形成,肾小管多灶性萎缩。电镜下可见致密而不规则的嗜锇性髓样小体。目前Fabry病无有效的根治手段,合并肾损伤主要以护肾、降蛋白,控制症状等对症治疗为主,主要药物应用为ARB类药物,如氯沙坦钾、来氟米特等。结论Fabry病是一种罕见的X染色体伴性遗传疾病,肾脏损害是其最常见的临床表现之一,电镜下显示嗜锇性髓样小体是该疾病特征性病理表现,治疗上以对症治疗结合酶替代治疗为主并进行适当的遗传学干预以阻断该疾病的遗传。

Objective To investigate the clinical manifestation and renal pathology of Fabry disease which characteri zed with chronic nephritis syndrome as the main manifestation. Methods Retrospectively review the 2 cases of Fabry disease, which characterized as chronic nephritis syndrome as the main manifestation, the clinical signs and pathology were analyzed, and review of the relevant literature to master the methods of diagnosis and treatment. Results One case was male patient, the other was female patient, and onset age was 46 years old and 44 years old, 2 cases showed proteinuria, hematuria, hyperten-sion, and no characteristic of extra-renal manifestations. Under the light microscope, glomerular sclerosis rates were 30. 8%and 32. 1% respectively, significant swelling of glomerular podocytes, visible vacuoles formed in the cytoplasm, renal tubular multifocal atrophic were found. Dense and irregular osmiophilic myelin bodies also can be found. There is no effective cure methods for Fabry disease, combined with renal damage, the treatment mainly was to protect the kidney function, reducing protein, control symptom, the main medicine are ARB, such as losartan potassium, leflunomide. Conclusion Fabry disease is a rare genetic chromosome X diseases, renal damage is one of the most common clinical manifestation, under microscopic osmiophilic myelin bodies is the pathological finding, symptomatic treatment with enzyme replacement therapy are the main treatment, and combined with the genetics of appropriate intervention to block the genetics of the disease.