IgG4相关腹膜后纤维化致肾衰竭10例临床分析  

CLINICAL FEATURES OF RENAL FAILURE CAUSED BY IGG4-RELATED RETROPERITONEAL FIBROSIS: AN ANALYSIS OF 10 CASES

作　　者：张伟[1] 薛峰[2] 王淑娟[1] 刘雪梅[1] 闫焕新[3] 杨国帅[3] ZHANG Wei;XUE Feng;WANG Shujuan;LIU Xuemei;YAN Huanxin;YANG Guoshuai(Department of Nephrology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肾内科,山东青岛266003 [2]青岛大学附属医院麻醉科,山东青岛266003 [3]青岛大学附属医院药学部,山东青岛266003

出　　处：《青岛大学学报（医学版）》2020年第1期92-94,共3页Journal of Qingdao University(Medical Sciences)

摘　　要：目的通过分析IgG4相关性腹膜后纤维化致肾衰竭病人的临床资料,了解导致肾衰竭的原因、糖皮质激素治疗效果和影响肾功能预后的因素。方法对在我院住院期间经病理及临床特征确诊的10例IgG4相关性腹膜后纤维化致肾衰竭病人的临床资料进行回顾性分析。结果本组均为男性病人,平均起病年龄(64.2±10.0)岁。血清IgG4浓度升高9例,贫血9例,抗核抗体(ANA)滴度异常升高2例。就诊时5例病人为急性肾衰竭(ARF),5例为慢性肾脏病(CKD,3期或3期以上)基础上的ARF,1例肾活检证实合并IgG4相关肾小管间质肾炎。经糖皮质激素等综合治疗,5例ARF病人血肌酐(SCr)恢复正常;5例CKD基础上的ARF病人中1例SCr恢复正常,4例恢复到基线水平。糖皮质激素治疗结束后SCr水平较治疗前明显降低(t=5.2,P<0.05)。结论该病肾衰竭的原因主要是腹膜后纤维化导致的梗阻性肾病;糖皮质激素治疗能延缓肾衰竭进展,部分病人SCr降至正常水平;肾功能预后与确诊时机和恰当的治疗密切相关。Objective To investigate the causes of renal failure,the therapeutic effect of glucocorticoids,and the influencing factors for the prognosis of renal function by analyzing the clinical data of patients with renal failure caused by IgG4-related retroperitoneal fibrosis.Methods A retrospective analysis was performed for the clinical data of ten patients with renal failure caused by IgG4-related retroperitoneal fibrosis who were diagnosed by pathological and clinical examinations.Results All patients were male with an age of onset of(64.2±10.0)years.Among these patients,nine had an elevated serum IgG4 concentration,nine had anemia,and two had an abnormal increase in the titer of antinuclear antibody.Of all patients,five had acute renal failure(ARF)when they attended the hospital,and the other five had ARF on the basis of chronic kidney disease(CKD)(stage 3 or above);one patient also had IgG4-related tubulointerstitial nephritis confirmed by renal biopsy.After multimodality therapy including glucocorticoids,five ARF patients had normal serum creatinine(SCr);among the five patients with ARF on the basis of CKD,one had normal SCr and four had SCr returned to the baseline level.There was a significant reduction in SCr after the treatment with glucocorticoids(t=5.2,P<0.05).Conclusion The leading cause of renal failure is obstructive nephropathy caused by retroperitoneal fibrosis.Glucocorticoid therapy can delay the progression to renal failure,and some patients may have a normal SCr level.Recovery and prognosis of renal function is closely associated with the timing of diagnosis and proper treatment.

关 键 词：肾功能不全 免疫球蛋白G 腹膜后纤维化 疾病特征 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]