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首页> 美国卫生研究院文献>CEN Case Reports >De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation
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De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

机译：活体供肾肾移植后31年从头开始的髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）相关性肾小球肾炎

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A 61-year-old woman was admitted to our hospital because of an unexpected rise in serum creatinine (sCr) level with proteinuria and microhematuria. She had undergone living-donor kidney transplantation 31 years before for end-stage renal disease caused by chronic glomerulonephritis (GN). On admission, her sCr was 1.27 mg/dL which was increased from 0.6 mg/dL, urinary protein/creatinine ratio was 1.39 g/gCr, and urinary red blood cell count was more than 100 per high power field. The allograft biopsy revealed crescentic glomerulonephritis with moderate to severe tubulointerstitial inflammation. Immunofluorescence staining yielded only a minimal staining for immunoglobulin A, and negative C4d in peritubular capillary. Since increased myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titer of 45.5 U/mL was detected, we made the diagnosis of post-transplant MPO-ANCA-associated GN. She was treated with three doses of bolus methylprednisolone (500 mg) followed by oral prednisolone therapy. Her sCr was stable at 1.20 mg/dL thereafter. ANCA-associated GN should be considered in older kidney transplant patients with new-onset urinary abnormalities because typical systemic symptoms and vasculitis in other organs might be masked by maintenance immunosuppression.
机译：一名61岁的妇女因蛋白尿和微血尿的血清肌酐（sCr）水平意外升高而入院。她因慢性肾小球肾炎（GN）导致的终末期肾脏疾病接受了活体肾脏移植31年。入院时，她的sCr为1.27 mg / dL，高于0.6 mg / dL，尿蛋白/肌酐比为1.39 g / gCr，每高倍视野尿尿红细胞计数超过100。同种异体移植活检显示新月型肾小球肾炎伴中度至重度肾小管间质炎症。免疫荧光染色仅产生最小程度的免疫球蛋白A染色，而肾小管周毛细管中的C4d阴性。由于检测到髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）滴度增加至45.5 U / mL，因此我们对MPO-ANCA移植后GN进行了诊断。她接受了三剂大剂量甲基强的松龙（500毫克）推注，然后口服泼尼松龙治疗。此后她的sCr稳定在1.20 mg / dL。在新发泌尿异常的老年肾脏移植患者中，应考虑与ANCA相关的GN，因为其他器官的典型全身症状和血管炎可能会被维持免疫抑制所掩盖。

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