肾结节病致急性肾损伤一例及文献复习

目的分析肾结节病(RS)并急性肾损伤(AKI)患者的临床特点、诊治和预后,提高临床诊治水平。方法分析北戴河康复疗养中心全军肾病中西医结合治疗中心收治的1例以AKI受累为首发症状的结节病患者的临床表现、影像和病理学特点,结合文献复习并总结了来自中国报告的结节病AKI病例特点。结果本例RS仅以AKI为主要表现,肾组织病理示:R S并亚急性小管间质病变,即:肾间质可见多个肉芽肿样结构形成,内有较多的单核、淋巴细胞浸润,肾间质弥漫单核淋巴细胞浸润伴轻度纤维化,以醋酸泼尼松治疗后,肾功能明显改善(eGFR由7.05 mL/min 2年后恢至49.13 mL/min)。16例文献复习示:肾功能恢复正常5例,肾功能明显改善8例,3例因误诊、未使用激素正规治疗,最后肾功能恶化转为血透维持。结论结节病急性肾功能损伤者对糖皮质激素治疗敏感,早诊断、早治疗是关键。

Objective To analyze the clinical characteristics,diagnosis,treatment and prognosis of patients with renal sarcoidosis(RS)and acute renal injury(AKI),so as to improve the level of clinical diagnosis and treatment.Me thods The clinical manifestations,imaging and pathological characteristics of a case of sarcoidosis with AKI involvement as the first symptom treated in the Integrated traditional Chinese and Western Medicine Treatment Center for Nephropathy in the Whole Army Beidaihe Rehabilitation and Recuperation Center were analyzed.Combined with literature review,the characteristics of AKI cases of sarcoidosis reported from China were summarized.Re s ults In this case,AKI was the main manifestation of RS.Renal histopathology showed that RS was complicated with subacute tubulointerstitial lesions,that was,multiple granulomatous structures could be seen in the renal interstitium,with more mononuclear and lymphocyte infiltration,diffuse mononuclear lymphocyte infiltration in the renal interstitium with mild fibrosis.After treatment with prednisone acetate,renal function was significantly improved(eGFR recovered from 7.05 m L/min to 49.13 m L/min after 2 years).The review of 16 cases showed that renal function returned to normal in 5 cases,renal function improved significantly in 8 cases,3 cases were misdiagnosed and did not use hormone formal treatment,and finally the deterioration of renal function turned to hemodialysis maintenance.Conclus ion Patients with acute renal function injury in sarcoidosis are sensitive to glucocorticoid treatment.Early diagnosis and early treatment are the key factors.