- 期刊
溶血性尿毒症併發高血壓症之一例報告
Hemolytic Uremic Syndrome Complicated with Hypertension-A Case Report-
摘要
溶血性尿毒症症候羣在教科書及圖外文獻上屬常見，但在我國仍屬少見。本病例符合診斷的三要件：1)溶血性貧血2)急性腎衰竭3)血小板減少，並經腎臓切片證實。剛開始的表現似肝炎及急性腎小球腎炎，並有出血傾向，後續有神經學症狀。在免疫學方面持續有低濃底的IgG及補體，加上腎臓切片螢光免疫染色顯示有局部IgM, C3, C4及少量C(下標 1q)的沈著，可能與免疫複合體有關。該病人經三次腹膜透析、屢次輸血、控制血壓及維持電解質平衡，倖能存活，但已呈慢性腎衰竭現象。對於小孩之急性腎衰竭若能將該症候羣列入鑑別診斷，則可發現更多病例。
關鍵字
無資料並列摘要
Hemolytic uremic syndrome (HUS) has been reported not infrequently in the literature, but it seems to be rare in Taiwan. This report describes a typical case of HUS with characteristic clinical triad of microangiopathic hemolytic anemia, acute renal failure and thrombocytopenia. The renal biopsy showed that the glomerular capillary wall was widened and the lumens were obliterated. Fragmented RBCs, foamy appearance and cell proliferation in the mesangium were found. Arteriolar thrombi and tubointerstitial fibrosis ere also noticed in some areas. Immunofluorescence study demonstuated focal glomerular depositions of IgM, C3, C4, C(subscript 1q) and fibrin. Persistent low serum levels of IgG and complements suggest the possibility of circulating immune complex in the pathogenesis of this disease. The patient had received peritoneal dialysis three times because of azotemia. Supportive measures such as blood transfusions, antihypertensive drugs and correction of fluid and electrolytes imbalance were also given. She was finally discharged with elevated BUN and hepertension.
延伸閱讀
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