Ⅱ型冷球蛋白血症肾脏损害1例  

Renal impairment induced by type Ⅱ cryoglobulinemia

作　　者：尹广[1] 刘正钊[1] 曾彩虹[1] 

机构地区：[1]国家肾脏疾病临床研究中心,金陵医院,南京大学医学院

出　　处：《中华老年多器官疾病杂志》2016年第8期628-632,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：冷球蛋白血症肾损害临床上极易漏诊误诊。加深对冷球蛋白血症肾损害的临床病理特点的认识，特别是提高做冷球蛋白检查的意识，是减少漏诊误诊的关键。本文讨论1例Ⅱ型冷球蛋白血症肾脏损害，临床表现为急性肾炎综合征，血肌酐升高并高血压，冷球蛋白明显升高伴类风湿因子阳性，补体降低，无丙肝感染。入院后通过临床-病理-实验室检查相结合，特别是冷球蛋白分析，诊断为Ⅱ型冷球蛋白血症（单克隆IgM＋多克隆IgG）肾脏损害。希望通过复习本病例，提高临床医师对该病的认识及诊断水平。Missed diagnosis and misdiagnosis of cryoglobulinemia with renal impairment are very common in clinical practice. It is essential to grasp the clinicopathological characteristics of cryoglobulinemia with renal impairment, especially to the awareness of checking cryoglobulins in order to reduce the missed and misdiagnosis. In this article, we reported 1 case of renal impairment induced by cryoglobuiinemia, with clinical manifestations of acute nephritic syndrome, elevated serum creatinine and hypertension. The patient had increased cryoglobulin level but decreased complement level, and were positive to rheumatic factor but negative to hepatitis C virus. After admission, the patient was finally diagnosed as renal involvement associated with type Ⅱ cryoglobulinemia （ monoclonal IgM ＋ polyclonal IgG） based on clinical, laboratory and pathological findings, especially for cryoglobulin. We hoped that this report will promote the awareness and diagnosis of the disease for clinicians.

关 键 词：冷球蛋白血症 肾脏损害 类风湿因子 膜增生性.肾小球肾炎 

分 类 号：R692[医药卫生—泌尿科学]