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Anti-Glomerular Basement Membrane Disease Associated with Membranous Nephropathy: A Case Report and Literature Review

抗腎絲球基底膜疾病併膜性腎病變:一病例報告和文獻回顧

摘要


抗腎絲球基底膜疾病合併膜性腎病變是相當少見的,我們報告一位66歲婦女,併有血尿、咳血、發燒以及急性腎衰竭,血清中抗腎絲球基底膜抗體為1:160。腎臟切片在螢光染色下,所見為細胞性半月狀體、彌漫性腎絲球基底膜增厚和沿著微血管壁的顆粒性沈積,而不是線性沈積。我們嘗試使用類固醇和mycophenolate mofetil(MMF, Cellecpt(上標 ®));但病人最後死於敗血症。回顧文獻,合併有抗腎絲球基底膜疾病及膜性腎病變的預後相當不好,尤其不好的預後因子存在時。

並列摘要


Anti-glomerular basement membrane (GBM) disease associated with membranous nephropathy (MN) is rare. We reported a 66-year-old woman with hematuria, proteinuria, hemoptysis, fever, and acute renal failure. The serum titer of anti-GBM autoantibody was 1:160. The renal biopsy showed cellular crescent, diffuse thickening of glomerular basement membrane, and a granular but not linear pattern of immunofluorescence along the glomerular capillary wall. Corticosteroid and mycophenolate mofetil (MMF) were tried, but she died of sepsis. Review of the literature suggests that the outcome of patients with combined anti-GBM disease and MN was poor, especially if poor prognostic factors existed.

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