肿瘤及重金属相关膜性肾病的诊断与治疗

Diagnosis and treatment for tumor-and heavy metals-related membranous nephropathy

膜性肾病是引起成人肾病综合征最常见的病因之一,按其病因可分为原发性和继发性,其中继发性膜性肾病约占总体膜性肾病的1/3。肿瘤及药物相关膜性肾病又是继发性膜性肾病中有意义、也有一定争议的病因,临床需要关注并加强甄别。虽然目前尚不能够准确区分肿瘤相关性膜性肾病与肿瘤合并特发性膜性肾病,但临床应注意:对于中老年膜性肾病患者,要警惕肿瘤的存在,注意肿瘤的筛检;对于发现肿瘤的患者,应注意监测肾损害指标,及时发现肾脏损害并给予干预治疗;对于中老年膜性肾病肾病综合征患者,在应用激素免疫抑制剂治疗前及治疗过程中,也要注意排除肿瘤的可能性。对于有汞接触史的膜性肾病患者,要注意排除汞中毒相关膜性肾病。

Membranous nephropathy (MN)is one of the most common causes of nephrotic syndrome (NS)in adults,which can be divided into the primary and secondary types.The secondary MN accounts for about 1 /3 of the total MN.Among the secondary MN,the tumors-and drugs-related MN is of significance and controversial,which need to be paid attention to and screened clinically.Although it is hard to differentiate accurately between tumors-related MN and IMN complicated with tumors,the following should be noted:the existence of tumors should not be ignored in middle-elderly patients with MN,which should be screened carefully;if the tumor is found,indexes of early renal damage should be measured for proper diagnosis and necessary interfering treatment;and for nephrotic syndrome in the middle-elderly patients with MN,before and during the application of corticosteroids and immunosuppressants,the possibility of tumors should also be ruled out.For MN patients who have a history of exposure to mercury,attention should be paid to exclude the mercury poisoning-related MN.