结节病的肾脏受累:组织学表现和临床过程

S. Naderi, K. Amann, U. Janssen
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引用次数: 3

摘要

结节病引起的肾功能衰竭很少见,其长期预后的资料也很少。探讨结节病累及肾脏的模式、临床病程及长期治疗效果。进行了一项单中心回顾性研究,回顾了肾脏活检和医学图表。2005年1月至2016年12月,7例结节病患者接受了肾活检。这相当于在我们机构进行的434例天然肾脏活检中1.6%的频率。所有患者均表现为肾功能衰竭。肉芽肿性间质性肾炎5例,无肉芽肿性肾钙质沉着症间质性肾炎各1例。3例患者合并肾小球疾病:IgA肾病(n = 2),膜性和局灶性增生性肾小球肾炎(n = 1)。大多数患者(n = 5)表现为高钙血症。所有患者最初分别口服强的松龙1mg /kg/天(n = 3)或0.5 mg/kg/天(n = 4),随后逐渐减量或停药。一名患者在18个月后开始服用硫唑嘌呤以避免使用类固醇。平均随访59个月后,平均估计肾小球滤过率(eGFR)从发病时的19±7 mL/min提高到49±16 mL/min。没有病人需要透析。所有开始使用强的松龙1 mg/kg/天的患者都发生了一过性糖尿病,而使用0.5 mg/kg/天的患者没有发生糖尿病。两组间肾功能改善无差异。GIN是结节病合并肾功能衰竭患者最常见的诊断。多数为初始高钙血症。早期类固醇治疗可导致肾功能持续改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Renal involvement in sarcoidosis: Histologic findings and clinical course
Renal failure in sarcoidosis is rare and data on its long-term outcome are scarce. To investigate the pattern of renal involvement in sarcoidosis, its clinical course and response to treatment in the long-term. A single-center retrospective study with review of renal biopsies and medical charts was performed. Between January 2005 and December 2016, seven patients with sarcoidosis underwent a kidney biopsy. This is equivalent to a frequency of 1.6% in a total of 434 biopsies from native kidney performed in our institution. All patients presented with renal failure. Five patients had granulomatous interstitial nephritis (GIN) and one patient each interstitial nephritis without granuloma and nephrocalcinosis. Three patients had concomitant glomerular disease: IgA nephropathy (n = 2), membranous and focal proliferative glomerulonephritis (n = 1). Most patients (n = 5) presented with hypercalcemia. All patients initially received oral prednisolone 1 mg/kg/day (n = 3) or 0.5 mg/kg/day (n = 4), respectively, with subsequent tapering or suspension. One patient was started on azathioprine after 18 months to spare steroids. After a mean follow-up of 59 months mean estimated glomerular filtration rate (eGFR) had improved from 19 ± 7 at presentation to 49 ± 16 mL/min. No patient required dialysis. All patients started on prednisolone 1 mg/kg/day developed transient diabetes mellitus while patients on 0.5 mg/kg/day did not. Renal function improvement did not differ between both treatment groups. GIN was the most common diagnosis in sarcoidosis patients with renal failure. Initial hypercalcemia was observed in the majority. Early steroid treatment lead to sustained renal function improvement.
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Nephrology @ Point of Care
Nephrology @ Point of Care UROLOGY & NEPHROLOGY-
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