表 1 WBC 7,700/μ C3 142 mg/d Eos 2.3 C4 41 mg/d ph 7.0 Hb 12 g/d IgG 984 mg/d 2+ TP 6.9 g/d IgA 323 mg/d 3+ Alb 3.7 g/d IgM 110 mg/d 1+ BUN 19.2
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1 症 例 報 告 要 14 5 Cr 1.7 mg/d egfr 45.0 m /min/1.73 m 2 β2mg 45,400 μg/ IgA 序 Mycoplasma pneumoniae 症 旨 言 例 症 例 :14 主 訴 : 家 族 歴 : 既 往 歴 :3 2 生 活 歴 : 現 病 歴 : mg/ 30 mg/ scr 1.7 mg/d 27 入 院 時 現 症 : cm 0.9 SD 38.4 kg 104/72 mmhg 94/ 37.2 C SpO 2 96 入 院 時 検 査 所 見 : scr 1.66 mg/d egfr 50.3 m /min/1.73 m 2 Schwartz C3 142 mg/d C4 41 mg/d IgA 323 mg/d PA RBC > 100/HPF 2+ U-TP/U-Cr 1.1 g/gcr β2 45,400 μg/d 表 cm cm Key words / / / IgA /
2 表 1 WBC 7,700/μ C3 142 mg/d Eos 2.3 C4 41 mg/d ph 7.0 Hb 12 g/d IgG 984 mg/d 2+ TP 6.9 g/d IgA 323 mg/d 3+ Alb 3.7 g/d IgM 110 mg/d 1+ BUN 19.2 mg/d ASO 29 IU/m Cre 1.66 mg/d PA 640 RBC >100/HPF UA 6 mg/d ANA <40 isomorphic Na 139 meq/l SS-A WBC 1 4/HPF K 4.28 meq/l SS-B Cast Cl meq/l MPO-ANCA <10 EU U-TP/U-Cr 1.1 CRP 1.75 mg/d PR3-ANCA <10 EU β2-mg 45,400 μg/ ESR 66/102 mm GBM <10 EU NAG 19.8 U/ β2-mg 5.9 mg/ ds-dna <10 IU/m FENa 1.5 egfr 50.3 m /min/1.73 m 2 図 1 入 院 後 経 過 1: 図 m /12 hr Cr 1.7 mg/d 100 mg/ 1 11 腎 病 理 所 見 :
3 図 2 PAS a b c d debris 図 3 electron dense deposit IgA C debris
4 図 2 IgA C3 electron dense deposit 図 3 IgA 入 院 後 経 過 2: ± IgA 2+ 考 察 IgA Wen 1 IgA IgA IgA IgA Praga TINU Mycoplasma pneumoniae Pasternack 26 9 Andrews 24 6 IgA 8 IgA IgA
5 IgA 結 論 IgA 文 1 Wen YK, Chen ML: The spectrum of acute renal failure in IgA nephropathy. Ren Fail 2010; 32: Praga M, González E: Acute interstitial nephritis. Kidney Int 2010; 77: Kobayashi Y, Honda M, Yoshikawa N, Ito H: Acute tubulointerstitial nephritis in 21 Japanese children. Clin Nephrol 2000; 54: Waites KB, Talkington DF: Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004; 17: , table of contents : Andrews PA, Lloyd CM, Webb MC, Sacks SH: Acute interstitial nephritis associated with Mycoplasma pneumoniae infection. Nephrol Dial Transplant 1994; 9: Saïd MH, Layani MP, Colon S, Faraj G, Glastre C, Cochat P: Mycoplasma pneumoniae-associated nephritis in children. Pediatr Nephrol 1999; 13: Suzuki K, Hirano K, Onodera N, Takahashi T, Tanaka H: Acute IgA nephropathy associated with mycoplasma pneumoniae infection. Pediatr Int 2005; 47: Pasternack A, Helin H, Vänttinen T, Järventie G, Vesikari T: Acute tubulointerstitial nephritis in a patient with Mycoplasma pneumoniae infection. Scand J Infect Dis 1979; 11: 献 Mycoplasma pneumoniae-associated acute tubulointerstitial nephritis with gross hematuria and transient renal dysfunction Maiko Hinokiyama 1, Ken Hatae 1, Hikaru Kanemasa 1, Kaneyasu Nakagawa 2, Tatsuo Harada 1, Shunji Hikino 1, Yoko Takeda 1, Satoshi Hisano 3 1 Department of Pediatrics, Japanese Red Cross Fukuoka Hospital 2 Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital 3 Department of Pathology, Faculty of Medicine, Fukuoka University Mycoplasma pneumoniae infection is responsible for both respiratory and extra respiratory symptoms, but renal involvement is rare. We here report a 15-year-old girl with gross hematuria appeared 5 days after the onset of low-grade fever and cough. Because of her proteinuria and moderate renal dysfunction, she was referred to our hospital. She was diagnosed as Mycoplasma pneumoniae pneumonia. But hypertension, oliguria and hypocomplementemia were absent, which are often seen in case of acute nephritis. Because her proteinuria and hematuria persisted even after her pneumonia improved, and tubular dysfunction was detected, a percutaneous renal biopsy was performed. The main histopathological finding was acute interstitial nephritis associated with mild IgA nephropathy. Her renal dysfunction was self-limiting, and subsequently she made a full recovery, except for microscopic hematuria. We conclude that Mycoplasma pneumoniae infection had an influence on the development of acute interstitial nephritis. Key words : acute interstitial nephritis, Mycoplasma pneumoniae, renal dysfunction, gross hematuria
BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI
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1 2 2 ANCA pouci immune IgG C3 ANCA 68 '01 '02 7 UN 14mg/dl, Cr 0.7 mg/dl, -, - ' UN 45mg/dl, Cr 2.4 mg/dl, Ht 29.5%, 4+, cm 61
1 2 2 ANCApouci immune IgG C3 ANCA 68 '01 '02 7 UN 14mg/dl, Cr 0.7 mg/dl, -, - '03 2 3 31 UN 45mg/dl, Cr 2.4 mg/dl, Ht 29.5%, 4+, 3+ 4 14 156.0 cm 61.5 kg 36.9 158/92 mmhg 90 1. ANCA 2. 3. IgG4 deposit
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24 シンポジウム Ⅲ 要旨 NPPV NPPV 緒 IPF 4 5 1 IPF 2004 2 QOL 179 10 現 10 18 2008 10 言 状 3.4 8.3 76.2 41 37.2 13.6 3 1 症 例 呈 示症例 患者 61 主訴 既往歴 30 45 家族歴 喫煙歴 飲酒歴 職歴 現病歴 13 NSIP 15 1 HOT 15 7 2010 年 6 月 25 表 1 1998
/12/28 UP 3+, TP 4.2g/dl, Alb 1.9g/dl PSL 50mg/day 1/17 PSL 45mg/day PSL 2006/4/4 PSL 30mg/day mpsl mpsl1000mg 3 2 5/ :90 / :114/64 mmhg
17 2005/12/28 UP 3+, TP 4.2g/dl, Alb 1.9g/dl PSL 50mg/day 1/17 PSL 45mg/day PSL 2006/4/4 PSL 30mg/day mpsl mpsl1000mg 32 5/8 36.1 :90 /:114/64 mmhg 166.2 cm64.3 kg 3.9 g/dl 1.6 g/dl 382 mg/dl 408 mg/dl
72 20 Ope / class Alb g/ cm 47.9kg : /min 112/60m
72 20Ope 68 69 2006 4 50 20 / 52 2006 4 1 2006 4 4 24 class 699.4 5 2 5 23 6 6 15 6 19 6 16 Alb2.03+ 7.5g/ 6 21 153.5cm 47.9kg : 36.7 89/min112/60mmHg (-) (-)S1 S2 S3(-) S4(-) - - 6 15 (+) TP4.9g/dl Alb2.0g/
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