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 LDL252 mg/dl 1 Up3+ occult blood1+ 3476mg/dlSelectivity Index 0.28 CCr 55ml/min Minimal change Minimalchange IgA,M,G C3,Fiblinogen 15 PAS 1 minor abnormality retrospective Key Word LDL MCNS FSGS 119
WBC1 4500 / l Stab 1.0 % Seg 90.0 % Lympho 5.5 % Mono 2.5 % Eosino 0.0 % Baso 1.0 % RBC 465 10 4 / l Hb 14.2 g/dl Ht 41.7 % Plt 31.4 10 4 / l TP 3.9 g/dl ALB 1.6 g/dl UA 8.2 mg/dl BUN 33.6 mg/dl Cr 1.1 mg/dl TG 382 mg/dl Tcho 408 mg/dl HDL-C 72 mg/dl LDL-C 252 mg/dl BS 96 mg/dl T-Bi l0.4 mg/dl AST 21 U/l ALT 18 U/l LDH 227 U/l CK 91 U/l ALP 316 U/l Na 142 meq/l K 4.9 meq/l Cl 105 meq/l Ca 8.0 mg/dl IgG 118 mg/dl IgA 153 mg/dl IgM 89 mg/dl CH 5057 U/ml P-ANCA 1.3U/ml C-ANCA 1.3U/ml color darkyellow Up 3 occultblood1 gravity 1.019 ph 6.0 ketonebody RBC 10-19 /HPF WBC 30-49 /HPF Up(spoturine) 3476 mg/dl SelectivityIndex 0.28 Ccr 55 ml/min segmental PAM 2 Masson 3 background depositdeposit MRI 1 30mg 1 10mg 1 4 5g 2006/5/18 LDL LA-15 1 4L5 2 650mg/day 300mg/day LDL 2 3 5/26 Alb 2.9 /dl 5/27 1 25mg 120
第 46 回神奈川腎炎研究会 図1 光顕所見 PAS 染色 図2 光顕所見 PAM 染色 図3 図4 図5 蛍光抗体法 121 画像所 入院後の経過
LDL 2005 MusoLDL 94 MCNS FSGS LDL LDL-Aphresis 17 2005 12 28 3+ 0.2g/dl 1.9g/dl 1 50ml 2006 1 17 1 45ml 4 4 30ml 1 1,000mg 3 2 5 8 90 / 64.3kg 10kg 3.9g/dl 122
1.6g/dl 382mg/dl 408mg/dl LDL- 250mg/dl 3+1+ 3,476mg/dl selectivity index 0.28 55ml/ minimal change PAS 15 minor abnormality retrospective PAM IgA IgM IgG C3 fibrinogen deposit deposit minimal change minimal change FGS MRI 1 30mg 1 100mg 1 4 5g 2006 5 18 LDL-Aphresis LA-151 4g 2 1 650mg 1 300mg LDL-Aphresis 2 3 2.9g 5 27 1 25mg 123
LDL- Aphresis 2005 LDL-Aphresis 94 1 MCNS FGS 2 LDL-Aphresis 25100CC LDL-Aphresis 1 1 1 30ml 2 LDL-Aphresis minimal change 2 LDL-Aphresis 4 30mg 10 1 1 1 LDL- Aphresis FDP 44 LDL-Aphresis 124
LDL- Aphresis LDL-Aphresis 100mg 30mg minimal FGS 1 CT Minimal FGS 1 50ml 50mg 3 3 45mg 2 5mg 30mg 30mg 2 15mg 8 selectivity index selectivity index 1+ 1+ 26 50mg 125
1 30mg 30mg LDL-Aphresis immune complex Aphresis immune complex LDL-Aphresis immune complex FGS 01 02 03 FGS 04 PAM 05foamy 06 foamy change 07 PAM foamy foamy change 08 foot process fusion collapse 09 17 GBM minimal change minimal change disease GBM MCNS 01 proximal distal oxalosis 02 distal proximal 03minor glomerular abnormality proximal 126
04 proximal 05 06 07 diffuse minimal change nephrotic syndrome 08 micro particles immune deposits cell debris Aphresis MCNS 1 1.3 1.4 prerenal hypovolemic Aphresis LDL- Aphresis 1 LDL-Aphresis interaction LDL-Aphresis 1 1 LDL-Aphresis 50 30 speculation platelet factor 4 4 4 cationic anionic charge neutralize 127
20 laboratory Investigation LDL-Aphresis PF4 10 PF4 LDL-Aphresis oxidize LDL LDL-Aphresis LDL-Aphresis 2 dose LDL-Aphresis Savin Palb assay LDL-Aphresis minimal change 50mg minimal minimal minimal FGS minimal FGS MCNS FGS MCNSsecondary secondary FGS idiopathic MCNS FGS FGS minimal change FGS 2 3 128
3 129
腎炎症例研究 23 巻 2007 年 山口先生 _01 山口先生 _06 重松先生 _02 山口先生 _02 山口先生 _07 重松先生 _03 山口先生 _03 山口先生 _08 重松先生 _04 山口先生 _04 山口先生 _09 重松先生 _05 山口先生 _05 重松先生 _01 重松先生 _06 130
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