误诊为膜性肾病的狼疮肾炎临床分析

Clinical Analysis of Lupus Nephritis Misdiagnosed as Membranous Nephropathy

目的 探讨狼疮肾炎(LN)与膜性肾病(MN)的临床特点及鉴别诊断要点,以减少误诊误治。方法 对误诊10余年的LN 1例的临床资料进行回顾性分析,并复习相关文献。结果 育龄期女性,因双下肢水肿伴泡沫尿13年就诊。10余年前首诊时肾脏病理检查诊断为Ⅰ期MN,予相应治疗缓解。10年间患者病情时有反复。2个月前患者因牙龈炎于当地诊所就诊,治疗4 d后出现双下肢水肿,尿中泡沫增多,尿量减少,遂转至我院。查体见双下肢轻度水肿,毛发较稀疏,颈部皮肤可见淡红色皮损。行肾穿刺活组织病理检查诊断为LN,给予针对性治疗19 d后,病情缓解出院。结论 系统性红斑狼疮通常累及多个器官和系统,肾脏是其主要累及的脏器之一,早期临床表现不典型,易误诊。临床鉴别LN与MN时,应重视病理及MN靶抗原检查,并仔细查体,认真鉴别诊断,以减少或避免误诊误治。

Objective To explore the clinical characteristics and key points of differential diagnosis between lupus nephritis(LN) and membranous nephropathy(MN),so as to reduce misdiagnosis and mistreatment.Methods The clinical data of one patient with LN misdiagnosed for more than 10 years were analyzed retrospectively,and the related literature was reviewed.Results A woman of childbearing age presented with edema of both lower limbs and foam urine for 13 years.At the initial diagnosis more than 10 years ago,renal pathology examination revealed stage I MN,and corresponding treatment was given for alleviation.The patient's condition had been fluctuating over the past 10 years.Two months ago,the patient went to the local clinic for treatment due to gingivitis.At 4 d after treatment,there was edema in both lower limbs,increased foam in urine,and decreased urine volume,so he was transferred to our hospital.Physical examination revealed mild edema in both lower limbs,sparse hair,and pale red skin lesions on the neck skin.Diagnosis of LN was made through renal biopsy and pathological examination,and her condition improved after targeted treatment for 19 d.Conclusion Systemic lupus erythematosus usually involves multiple tissues,organs and systems.The kidney is one of the main organs involved,and the early clinical symptoms are atypical.When differentiating LN from MN,we should pay attention to pathological examination and the examination of the target antigen of MN,and perform careful physical examination and differential diagnosis,to reduce or avoid misdiagnosis and mistreatment.