本文报道了1例老年男性患者,临床上存在皮肤紫癜伴肾脏损害,冷球蛋白升高,类风湿因子高滴度阳性,同时伴免疫球蛋白IgM升高,丙型肝炎抗体及RNA阴性.两年前第1次入住我科行肾活检误诊为膜增生性肾小球肾炎.患者虽经免疫抑制剂治疗病情改善,但此次停药3月后病情活动,尿检异常加重,肾功能恶化,再次入院后查冷球蛋白明显升高,重新仔细阅病理片后修正诊断为冷球蛋白血症肾损害,后经双重滤过血浆置换联合激素治疗,病情得到改善.本文通过分析此例非HCV相关冷球蛋白血症的诊治经过,以期提高临床医师对冷球蛋白血症特点的认识,避免贻误诊治,并进一步探求这类疾病更好的治疗方案.%A 70-years old with skin purpura, renal involvement, cryoglobulinemia, high rheumatoid factor level, and without hepatitis C was reported.Two years ago, he was diagnosed as membranoproliferative glomerulonephritis by renal biopsy, and was responded with immunosuppressive agents.However, the proteinuria and hematuria increased, and renal function aggravated after withdrawaling drugs for 3 months.Thus, he was admitted in our hospital again.Further laboratory tests showed that the level of cryolobulin was increased obviously.After reviewing renal biopsy specimen, the diagnosis was revised to cryoglobulinemia glomerulonephritis.After Double filtration plasmapheresis therapy the patient's condition was improved markedly.Conclussion:This text reported a case of cryoglobulinemia glomerulonephritis without hepatitis C.It may be helpful for the clinician to know more about the characteristics of cryoglobulinemia, to avoid the delay diagnose and treatment, and to seek an optimal therapeutic regimen.
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