以急进性肾小球肾炎为表现的糖尿病肾病合并IgA肾病误诊1例  

A case of misdiagnosis of diabetic nephropathy combined with IgA nephropathy presenting as rapidly progressive nephritis

作　　者：张杰 肖宗清 刘园园 庄育田[2] 吴汉利[2] ZHANG Jie;XIAO Zongqing;LIU Yuanyuan;ZHUANG Yutian;WU Hanli(School of Clinical Medicine,Shandong Second Medical University,Shandong Province,Weifang262500,China;Department of Nephrology,Yidu Central Hospital of Weifang,Shandong Province,Qingzhou262500,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊262500 [2]山东省潍坊市益都中心医院肾脏内科,山东青州262500

出　　处：《中国医药导报》2024年第27期194-196,F0003,共4页China Medical Herald

摘　　要：以急进性肾小球肾炎为表现的糖尿病肾病合并IgA肾病的病例目前报道甚少。本文回顾性分析山东省潍坊市益都中心医院接诊的患者1例,其早期表现为颜面及双下肢水肿、肉眼血尿、蛋白尿,进而表现为尿量减少、血肌酐进行性增高,结合临床表现、光镜及电镜病理结果诊断为糖尿病肾病合并抗中性粒细胞胞质抗体阴性血管炎肾损害,予以甲强龙联合环磷酰胺冲击治疗。因患者无血管炎表现,又行石蜡切片免疫荧光染色,明确诊断为糖尿病肾病合并IgA肾病(新月体型)。本文通过对该病例的报道及相关文献分析发现,在诊断过程中新鲜组织免疫荧光染色可能出现假阴性情况,通过适当的抗原修复方法,可最大限度地减少假阴性结果,提高免疫荧光染色的质量和可靠性,避免此类误诊。At present,cases of diabetic nephropathy combined with IgA nephropathy presenting as rapidly progressive nephritis are rarely reported.In this paper,a case of a patient seen at Yidu Central Hospital of Weifang,Shandong Province,whose early manifestations were facial and bilateral lower limb edema,hematuria,proteinuria,and then urine output decreased and blood creatinine increased progressively.Diabetic nephropathy combined with anti-neutrophil cytoplasmic antibodies-negative vasculitis renal damage was diagnosed by combining clinical manifestations,light microscopy,and electron microscopy pathology results,and was treated with Methylprednisolone combined with Cyclophosphamide shock therapy.Because the patient had no vasculitis manifestations,immunofluorescence staining of paraffin sections was also performed,and a definite diagnosis of diabetic nephropathy combined with IgA nephropathy(crescentic type)was made.This paper analyzes the case report and related literature and finds that false-negative situations may occur in fresh tissue immunofluorescence during the diagnostic process,and such misdiagnosis can be avoided by minimizing false-negative results and improving the quality and reliability of immunofluorescence staining through appropriate antigenic repair methods.

关 键 词：IGA肾病 急进性肾炎 糖尿病肾病 

分 类 号：R692.4[医药卫生—泌尿科学]