Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis as a Complication of Home Parenteral Nutrition

IF 0.7 Q4 UROLOGY & NEPHROLOGY

Case Reports in Nephrology and Dialysis Pub Date : 2022-03-14 DOI:10.1159/000522150

Hana Flogelová, E. Karaskova, K. Bouchalová, M. Rohanova, V. Latalova, T. Tichý, V. Tesar

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引用次数: 1

Abstract

Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.

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抗中性粒细胞胞浆自身抗体相关性肾小球肾炎是家庭肠外营养并发症

长期在家接受胃肠外营养（HPN）的患者偶尔会因慢性中心静脉导管（CVC）相关感染而发展为肾小球肾炎。以前报道的大多数病例是膜增殖性肾小球肾炎（MPGN）。这是一例16岁女孩因短肠综合征接受HPN治疗的病例报告。在接受HPN治疗11年后，她出现了急性肾损伤，伴有肉眼血尿、肾病范围蛋白尿和肾小球滤过率（GFR）降低。最初，人们怀疑MPGN与慢性菌血症有关，并假设这种情况将用抗生素和CVC替代治疗。然而，她的肾活检显示抗中性粒细胞胞浆自身抗体（ANCA）相关肾小球肾炎（AAG）。这与患者蛋白酶3-ANCA检测呈阳性的事实一致。甲基强的松龙脉冲（随后口服泼尼松）和利妥昔单抗的免疫抑制治疗导致病情缓解。她的肾小球滤过率和蛋白质排泄恢复正常。慢性菌血症作为长期HPN的并发症，可能导致各种类型的肾小球肾炎，包括需要免疫抑制治疗的AAG。

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来源期刊

Case Reports in Nephrology and Dialysis UROLOGY & NEPHROLOGY-

CiteScore

1.20

自引率

0.00%

发文量

审稿时长

10 weeks

期刊介绍： This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of nephrology and dialysis, including genetic susceptibility, clinical presentation, diagnosis, treatment or prevention, toxicities of therapy, critical care, supportive care, quality-of-life and survival issues. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed.