血液净化治疗冷球蛋白血症  

Continuous veno-venos hemodialysis therapy in patient with cryoglobulinemia

作　　者：成水芹[1] 龚德华[1] 季大玺[1] 

机构地区：[1]南京军区南京总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2014年第1期93-98,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：62岁男性,临床表现肾病综合征伴大量镜下血尿,血清肌酐升高、贫血、高黏质血症、血栓形成、冷球蛋白及免疫球蛋白IgM显著升高,血清免疫固定电泳可见κ型IgM条带。骨髓病理提示小淋巴细胞增生;肾活检病理诊断为冷球蛋白血症肾损害。行肾活检穿刺后患者血红蛋白进行性下降,B超见右肾下极旁108 mm×76 mm的血肿,行数字减影血管造影检查后立即床旁连续性静脉-静脉血液透析(CVVHD)治疗,即刻出现滤器前压升高,考虑高冷球蛋白堵塞滤器,予动脉端血液及透析液加温后,治疗得以继续,在行2次CVVHD治疗后,患者肾功能稳定,最终摆脱血液净化治疗。A 62 years old male was characterized by nephrotic syndrome with a large number of microscopic haematuria and elevated serum creatinine, associated with anemia, high level of cryoglobulin and immunoglobulin IgM, hyperviscosity syndrome, and thrombosis. Electrophoresis showed a monoclonal component which was classified as lgM kappa stripe. Bone marrow biopsy examination indicated lymphocyte proliferation. The diagnose of renal damage due to cryoglobulinemia was made. After renal biopsy, the hemoglobin decreased quickly. Renal ultrasound showed the size of hematoma was 108 mmx76 mm. DSA examination was performed and then immediately treated with continuous veno-venos hemodialysis （CVVHD） therapy. During the treatment, pre-filtration pressure rised to 450 mmHg immediately, the filter clogged quickly was considered, and then warmed arterial blood and the dialysate, the treatment could continued. After the CVVHD therapy for two times, the renal function was stable. Finally the patient got rid of continuous renal replacement therapy.

关 键 词：冷球蛋白血症肾损害 连续性静脉-静脉血液透析 滤器快速堵塞 

分 类 号：R692.5[医药卫生—泌尿科学]