1996 papilloma virus 2001 Bowen2002 12 2003 2 2002 9 10 AIHA PSL1mg/kg BMAPRCA parvovirus B19 PVB19 DNA PCR PV IgM 4PVB19 PRCA MAPPVB19DNA DNA PRCA IVIG;20 50g/ IVIG PVB19AIHA steroid 15 20mg/day 2003 4Evans 8 AIHA Rituximab PRCA 2004 1PSL 20mg/5mg 2 3kg 155 cm50.6 kg36.9 100/60 mmhg 100/ + - pitting edema < -, - 2 + 45 LDH HbA1c UIBC 8g 50ml/min Coombs LDH PRCA crisisivig 2004 2 Key Word B19 MPGN 120
RBC 225 x10 4 l Hb 8.5 g/dl Ht 26.2 % Plt 45.7 x10 4 l WBC 6200 l TP 4.4 g/dl Alb 2.4 g/dl alb 63.5 % 1 7.0 2 14.3 7.0 8.2 T.Bil 0.5 mg/dl BUN 17 mg/dl Cre 0.9 mg/dl Na 142 mmol/l K 4.1 mmol/l Cl 106 mmol/l Ca 4.2 mmol/l P 4.7 mg/dl AST 37 IU/l ALT 22 IU/l LDH 370 IU/l ALP 165 IU/l CRP 1.3 mg/dl TC 342 mg/dl TG 421 mg/dl HDL 52 mg/dl FBG 75 mg/dl HbA1c 2.3 % Fe 36 g/dl UIBC 124 g/dl Ferritin 6167 g/dl PT INR 0.89 APTT 20.0 sec ph 6.5 3 3 RBC 11-30 HPF WBC 11-30 HPF 8.43 g Ccr 50.5 min IgG 226 mg/dl IgA 28.9 mg/dl IgM 209 mg/dl CH50 3 C3 14 mg/dl C4 0 mg/dl Cryoglobulin Haptoglobin 9 mg/dl Coombs: D ID 5.9 dsdna 0.1 IU/ml C1q <1.0 g/ml <1.3 IU/ml GBM <10 U 121
1 0.03g/gCr 8g 47 Spike IgG IgM C3 C4 C1q +/- IgG IgG1 deposit B19 DNA turnover aplastic crisis Auther Clinical findings Histlogical findings PV detection Markenson AL, et al Am J Med, 1978 Wierenga KJJ, et al Lancet, 1995 Chakaravarty, Merry Postgrad Med J, 1999 Tlaymat et al Pediatr Nephrol, 1999 Challine-Lehmann D, et al Nephron, 1999 Tanawattanacharien S, et al AJKD, 2000 Komatsuda A, et al AJKD, 2000 Schmid ML, et al Ann Int Med, 2000 Nakazawa T, et al AJKD, 2000 Moudgil A, et al Kidney Intern, 2001 Takada S, et al Nephron, 2001 sickle cell anemia and hemolytic crisis Sickle cell disease, 7 Sickle cell desease and aplastic crisis FSGS or MCNS Prolif seg GN, FSGS MesPGN focal MesPGN PCR, serum SHP, 15 SHP 7/15 serum IgG 20/40 FSGS, MN, MCNS 17/20vs 13/20, AGN, Endocap PGN HIC acute prolif GN antigen, 4 23/96 HIVGN/FSGS/control DNA PCR ; Collapsing glomerulopathy DNA ; 78.3%, ISH 6 Endocap PGN PVB19 capsid antigen: negative 122
1978 sickle cell anemia FSGS FSGS DNA DNA monoclonal AIHA Common Variable Immunodeficiency CVI AIHA 11 AIHAPVB19 CVI AIHA (g/dl) (g/dl) (x10^4/é l) (IU/l) 8 7 6 5 4 3 2 1 0 12 10 8 6 4 2 0 60 50 40 30 20 10 0 800 600 400 200 0 PSL 20mg 30mg 40mg 20/5mg IVIG 0 30 60 90 120 Ret150 180 210 0 30 60 90 120 150 180 210 LD 2003 1202004 0 30 60 90 150 180 210 Sep. Oct. Nov. Dec. Jan. Feb. Mar. Apr. Plt PSL 20mg 30mg 40mg 20/5mg IVIG 0 30 60 90 120 150 180 210 2003 2004 Sep. Oct. Nov. Dec. Jan. Feb. Mar. Apr. Hb 12 10 8 6 4 2 0 TP Alb AIHA MPGN type I monoclonal Masson-Trichrome x100 123
PAS x400 PAM x400 HE x400 PAS x200 Gimsa x40 HE x40 124
? CVI MPGN AIHA ( ) Anemia MAP PRCA ( )? PSL PVB19 IVIG 1 B19 SLE criteria SLE IF C1q? SLE C1q B19 associated nephropathy SLE SLE SLE SLE 125
ACE inhibitor C4 0 0 1 C4 common variable immunodeficiency MPGN MPGN HSP HSP 7 30 HSP ACE SLE cytotoxic T cell T cell activate 126
IVIG 3g 3g 8g 1 2 01,02 mesangiocapillary MPGN establish PAM 03 PAM endocapillary GN matrix double control endocapillary GN endocapillary GN MPGN 04 matrix 05 mesangial cell mesangial matrix 06 MPGN like lesion 07 macrophage 08 B1endovasculitis peritubular capillaritis immune deposit immune depositic endocapillary GN 09 peritubular capillaritis 10 peritubular capillary 3 1 MPGN 1 HUS immune complex MPGN MPGN B19 2 127
hyper cellular lobulationvacuolization lobulation endocapillary matrix foam cell capillary foam cell capillary PAM double control capillary MPGN IgG IgM peripheral IgM peripheral IgG granular C3 peripheral IgG IgM C3 C1q SLE macrophage endothel paramesangium endothel paramesangium mesangial matrix SLE depositmesangial interposition mesangial cell partial interposition mesangial matrix deposit MPGN 19 MPGN 2003 Pediatric Nephrology immunoglobulin C3 mesangial peripheral pattern MPGN common variable immunodeficiency deposit MPGN 128
2 8g 8g 1 1 MCNS MCNS MPGN MPGN glomerulonephritis MPGN endocapillary glomerulonephritis MPGN secondary MPGNMPGN endocapillary MPGN secondary MPGNdouble control lobular GN double control MPGN RBC second line? mesangial cell 129
immune complex 130
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