临床病例评析——皮肤硬化高血压肾功能不全

Skin sclerosis,hypertension and renal insufficiency:a report of one case with literture review

目的提高临床对SSc合并高血压、肾功能不全的鉴别诊断水平。方法报道1例SSc合并高血压、肾功能不全患者的临床特点及诊治经过,并进行分析讨论。结果中年女性,SSc病史5年,出现头痛、肉眼血尿10 d,伴血压升高,实验室检查血肌酐升高,肾小球源性血尿,蛋白尿,补体低,ANA、抗dsDNA抗体、核周型ANCA阳性,肾活检病理示LN(Ⅳ型),予激素冲击、环磷酰胺、贝利尤单抗及对症治疗后症状缓解,狼疮病情活动指标恢复正常。结论SSc患者出现血压和肌酐升高,除考虑硬皮病肾危象外,应考虑有无其他疾病,必要时行肾脏穿刺活检病理检查以明确诊断,避免漏诊。

Objective To improve the differential diagnosis of systemic sclerosis(SSc)with hypertension and renal insufficiency.Methods The clinical characteristics,diagnosis and treatment of a SSc patient with hypertension and renal insufficiency were reported and discussed.Results A middle-aged female patient with a history of SSc for 5 years,headache and gross hematuria for 10 days was admitted.Abrupt increase in blood pressure and creatinine,glomerular hematuria,proteinuria,low complement C3 and C4,positive antinuclear antibody(ANA),anti-dsDNA antibody and perinuclear antineutrophil cytoplasmic antibody(pANCA)were presented.Renal pathology showed lupus nephritis(LN)(typeⅣ).After glucocorticoid pulse therapy,followed by cyclophosphamide,belimumab,and symptomatic treatment,the symptoms were relievedand lupus disease activity were decreased.Conclusion For SSc patients with increased blood pressure and creatinine,the presence of other diseases should be considered in addition to scleroderma renal crisis.Renal biopsy and pathological examination should be performed to confirm the diagnosis and avoid misdiagnosis.