Mesangiocapillary glomerulonephritis型の組織像をもち高ミオグロビン血症を伴う急性じん不全で発症した全身性エリテマトーデスの1例  [in Japanese] A Case of Systemic Lupus Erythematodes with Mesangiocapillary Glomerulonephritis, Myoglobulinemia and Acute Renal Failure  [in Japanese]

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症例は24才男子, 昭和54年12月上旬糸球体腎炎様の症状で発症し, 同月25日に発熱および下腿筋肉痛を主訴に当院内科に入院した. 諸症状及び検査成績は, SLE急性腎不全を示唆し, さらに血中および尿中のミオグロビンが高値を示した. ステロイド投与, 血液透析により症状改善BUN, クレアチニンも正常化したが第40病日肺炎を併発, 第72病日種々の抗生剤投与も効なく死亡した. 剖検上腎はMCGN型のループス腎炎の像を呈していた.<br>経過中我々は腎不全の原因として, ループス腎炎と高ミオグロビン血症性の急性尿細管壊死の関与を疑つた. 結果的に本例の糸球体病変はループス腎炎中まれで, かつ最も強い変化であるMCGN型で腎不全を引きおこすに十分な変化であり, ATNの存在を関連づける必要はないように思われた. しかしいずれに原因を求めても極めて希で, 貴重な1症例と思われたので, 多少の文献的考察を加えここに報告した.

A 25-Year-old male developed glomerulonephritis-ike symptoms, and was admitted to our hospital with fever and myalgia of the lower legs. He had marked tenderness on the muscles of the upper arms and lower legs, and pains at the interphalangeal joints of the feet. Laboratory examinations revealed leucopenia, LE cells, massive proteinuria, positive LE test, antinuclear antigen, low compliment titer, marked increase in blood urea nitrogen, creatinine and potassium, and increase in myoglobulin both in the serum and urine. Under the diagnosis of systemic lupus erythematodes (SLE) with acute renal failure, steroid hormone was administered and hemodiaiysis was begun. His symptoms and laboratory findings improved temporarily. However, pneumonia developed on the 40th day after admission, and he died on the 72nd day. Autopsy revealed mesangiocapillary glomerulonephritis (MCGN) with diffuse proliferation of the mesangium cells and thickening of the capillary loops in every glomerulus.<br>Although various classifications are used for lupus nephritis, MCGN type lupus nephritis is rarely seen. MCGN is the most aggressive histological change in lupus nephritis. Renal failure of this patient should be due to MCGN. Whether acute tubular necrosis due to myoglobulinemia played a role in causing renal failure was not clear, since there were no myoglobulin casts in the renal tissue. Laboratory findings did not support the presence of polymyositis or viral myositis, and the cause of myoglobulinemia was unknown.


  • Japanese Journal of National Medical Services

    Japanese Journal of National Medical Services 36(12), 1199-1204, 1982

    Japanese Society of National Medical Services


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