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首页> 外文期刊>CEN Case Reports >A case of secondary focal segmental glomerulosclerosis associated with malignant hypertension
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A case of secondary focal segmental glomerulosclerosis associated with malignant hypertension

机译：继发性局灶性节段性肾小球硬化症伴恶性高血压

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摘要

Focal segmental glomerulosclerosis (FSGS) is associated with various clinicopathological conditions, including hypertension. We report here a case of secondary FSGS associated with malignant hypertension. A 33-year-old man with a 1-month history of visual impairment and headache visited the Department of Ophthalmology at our hospital and was found to have hypertensive retinopathy and severe hypertension (230/160 mmHg). He was referred to our department based on suspected renal dysfunction. His blood pressure on admission was 250/130 mmHg. Physical examination and laboratory tests revealed hypertensive cardiac dysfunction, focal brain edema, renal dysfunction (serum creatinine, Cr 7.07 mg/dl, blood urea nitrogen, BUN 49.9 mg/dl), massive proteinuria (10.7 g/day), and thrombotic microangiopathy. Funduscopy showed exudate, hemorrhage, and papilledema. The cause of secondary hypertension could not be identified. He was treated for primary malignant hypertension, but required hemodialysis 3 days after admission due to anuria. Treatment with antihypertensive agents resulted in the gradual recovery of renal function, although heavy proteinuria continued with nephrotic syndrome. Renal biopsy performed 1 month after admission showed features of malignant nephrosclerosis with secondary FSGS. Hemodialysis was discontinued following further improvement in renal function and the most recent laboratory tests showed proteinuria 1.8 g/day and persistent renal dysfunction (BUN 36.5 mg/dl, Cr 3.14 mg/dl). Malignant hypertension may cause various injuries, including glomerular endothelial and epithelial cell injuries in glomerular hypertension and hyperfiltration, increase of the renin–angiotensin–aldosterone system, and endothelial–epithelial interaction, resulting in the development of secondary FSGS and heavy proteinuria.
机译：局灶性节段性肾小球硬化症（FSGS）与包括高血压在内的各种临床病理状况有关。我们在这里报告一例与恶性高血压相关的继发性FSGS。一名1个月视力障碍和头痛病史的33岁男子到我院眼科就诊，被发现患有高血压性视网膜病和严重高血压（230 / 160mmHg）。由于怀疑肾功能不全，他被转诊到我们部门。入院时血压为250/130 mmHg。体格检查和实验室检查发现高血压心脏功能不全，局灶性脑水肿，肾功能不全（血清肌酐，Cr 7.07 mg / dl，血尿素氮，BUN 49.9 mg / dl），大量蛋白尿（10.7 g / day）和血栓性微血管病。眼底镜检查显示渗出液，出血和乳头水肿。无法确定继发性高血压的原因。他因原发性恶性高血压接受了治疗，但由于无尿，入院后3天需要进行血液透析。用降压药治疗可导致肾功能逐渐恢复，尽管重蛋白尿仍伴有肾病综合征。入院后1个月进行的肾脏活检显示有继发性FSGS的恶性肾硬化。肾功能进一步改善后停止血液透析，最新实验室检查显示蛋白尿1.8克/天和持续性肾功能不全（BUN 36.5 mg / dl，Cr 3.14 mg / dl）。恶性高血压可能引起各种损伤，包括肾小球性高血压和高滤过引起的肾小球内皮和上皮细胞损伤，肾素-血管紧张素-醛固酮系统的增加以及内皮-上皮的相互作用，导致继发性FSGS的发展和重度蛋白尿。

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  • 来源
    《CEN Case Reports》 |2013年第1期|68-75|共8页
  • 作者

    Kumiko Fukuda; Akira Shimizu; Tomohiro Kaneko; Yukinari Masuda; Fumihiko Yasuda; Megumi Fukui; Seiichiro Higo; Akio Hirama; Akiko Mii; Shuichi Tsuruoka; Ryuji Ohashi; Yasuhiko Iino; Yuh Fukuda; Yasuo Katayama;

  • 作者单位

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Department of Analytic Human Pathology Nippon Medical School">(2);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Department of Analytic Human Pathology Nippon Medical School">(2);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Department of Analytic Human Pathology Nippon Medical School">(2);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Division of Diagnostic Pathology Nippon Medical School Hospital">(3);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

    Department of Analytic Human Pathology Nippon Medical School">(2);

    Division of Neurology Nephrology and Rheumatology Department of Internal Medicine Nippon Medical School">(1);

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  • 正文语种 eng
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  • 关键词

    Focal segmental glomerulosclerosis; Malignant hypertension; Malignant nephrosclerosis; Hypertensive emergency; Nephrotic syndrome; Thrombotic microangiopathy;

    机译：局灶性节段性肾小球硬化;恶性高血压;恶性肾硬化;高血压急症;肾病综合征血栓性微血管病;

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