急性腎不全を合併した急性リウマチ熱の成人例
書誌事項
- タイトル別名
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- An adult case of rheumatic fever complicated by acute renal failure.
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We experienced a rare adult case of rheumatic fever complicated by acute renal failure, in which poststreptococcal glomerulonephritis was considered to be the initial cause of renal failure. A 23 year-old man suddenly developed high fever, polyarthralgia and dyspnea about 10 days after the onset of flu-like symptoms. On admission, the prominent findings consisted of mild hypertension, tonsillar enlargement and generalized arthritis. Laboratory examination revealed marked leukocytosis, elevated erythrocyte sedimentation rate, a high level of C-reactive protein, high titers of anti-streptolysin-O and anti-streptkinase activity and mild renal failure. Urinalysis disclosed modest proteinuria, microscopic hematuria and granular casts. Despite the administration of cefotiam (4g/day for 3 days), a pericardial friction rub became audible and renal failure progressed. A diagnosis of rheumatic fever was made on the basis of Jones' criteria based on information obtained on chest X-ray, ECG and echocardiography, indicating the development of pen-and myo-carditis. Hemodialysis and administration of penicillin and prednisolone resulted in improvement in both renal failure and rheumatic fever. A renal biopsy specimen obtained 30 days after the onset of high fever revealed only a mild degree of mesangial expansion and glomerular infiltration by polynuclear leukocytes. In one glomerulus, hyalinization with a fibrous crescent body was evident accompanied by a severe degree of periglomerular fibrosis and cellular infiltration. In addition to the patient's clinical course, these pathological findings strongly suggested poststreptococcal glomerulonephritis as the etiology of the acute renal failure in the present case.
収録刊行物
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- 日本透析療法学会雑誌
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日本透析療法学会雑誌 23 (10), 1207-1211, 1990
社団法人 日本透析医学会
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詳細情報 詳細情報について
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- CRID
- 1390282679651931648
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- NII論文ID
- 130003720892
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- ISSN
- 18846211
- 09115889
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- 本文言語コード
- ja
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- データソース種別
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- JaLC
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- CiNii Articles
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- 抄録ライセンスフラグ
- 使用不可