摘要
青年女性,肾脏原发病不明,肾移植术后10个月,尿检异常4个月。术后血清肌酐(SCr)降至正常范围;术后曾因血白细胞计数低,将免疫抑制剂减量。术后6个月出现尿检异常,PRA抗体阳性,SCr轻度升高,外院移植肾活检示急性抗体介导的排斥反应,甲强龙冲击治疗,SCr降至正常范围,尿检未改善,我院移植肾重复活检示移植肾急性抗体介导的排斥反应、移植肾增生性肾小球肾炎伴单克隆免疫球蛋白沉积(IgG3,λ型),予甲强龙冲击、人免疫球蛋白注射剂静滴、硼替佐米联合地塞米松治疗后,SCr稳定,尿蛋白转阴。
A 30 y female with unidentifiable cause of renal failure presented with abnormal urinary dipstick test for 4 months post-kidney transplantation.The nadir serum creatinine of this patient was within normal range and the dosage of immunosuppressive agents was reduced due to low leukocyte count.Six months after the surgery,abnormal urine dipstick and panel-reactive antibody positivity occurred.An initial allograft biopsy indicated acute antibody-mediated rejection and methylprednisolone pulse therapy was initiated.Serum creatinine level returned to normal range while urine dipstick test was still abnormal.A repeat allograft biopsy at our institute revealed proliferative glomerulonephritis with monoclonal IgG deposits(PGNMID,IgG3-λ type) in addition to acute antibody-mediated rejection,which were treated with methylprednisolone pulse therapy,intravenous immunoglobulin and bortezomib were administered.Proteinuria remission and normal serum creatinine level were achieved after this treatment protocol.
作者
倪雪峰
文吉秋
NI Xuefeng;WEN Jiqiu(National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210016,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2019年第1期95-99,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
