结节病合并肾小球微小病变1例并文献复习

doi:10.3969/j.issn.1004-583X.2026.05.010

摘要/Abstract

摘要：

目的探讨结节病合并肾小球微小病变的发病机制及诊治过程。方法回顾性分析1例结节病合并肾小球微小病变的诊疗经过, 并复习国内外相关文献。结果我们报道了1例72岁女性,该患者2年前确诊结节病,曾接受甲泼尼龙、来氟米特及雷公藤多苷治疗。此次因双下肢水肿、大量蛋白尿及低白蛋白血症入院。入院后经肾穿刺活检证实,其肾脏病理类型为肾小球微小病变合并急性肾小管坏死。初始给予甲泼尼龙80 mg 1次/d治疗,后调整剂量至48 mg 1次/d。经系统治疗后,患者肾功能恢复,肾病综合征达到完全缓解;糖皮质激素逐步减量,随访期间肾病未再复发。结论本例是为数不多结节病单独合并肾小球微小病变且对激素治疗有效的病例之一。该研究结果或可为探索结节病合并肾小球微小病变的病因及潜在免疫机制提供新的思路。

关键词: 结节病, 肾小球微小病变, 糖皮质激素类

Abstract:

Objective To investigate the pathogenesis, diagnosis, and treatment of sarcoidosis complicated by minimal change glomerulopathy. Methods We retrospectively analyzed the diagnosis and treatment of one case of sarcoidosis complicated by minimal change glomerulopathy and reviewed the relevant literature from China and abroad. Results We report a 72-year-old woman who was diagnosed with sarcoidosis 2 years earlier and had previously received treatment with methylprednisolone, leflunomide, and tripterygium glycosides. She was admitted because of edema of the lower extremities, massive proteinuria, and hypoalbuminemia. After admission, renal biopsy confirmed minimal change glomerulopathy complicated by acute tubular necrosis. Methylprednisolone was initially administered at 80 mg once daily, and the dose was later adjusted to 48 mg once daily. After systematic treatment, the patient’s renal function recovered and nephrotic syndrome achieved complete remission. The glucocorticoid dose was gradually tapered, and no recurrence of nephrotic syndrome was observed during follow-up. Conclusion This case is one of the few reported cases of sarcoidosis complicated by isolated minimal change glomerulopathy and responsive to glucocorticoid therapy. The findings may provide new insights into the etiology and potential immune mechanisms of sarcoidosis complicated byminimal change glomerulopathy.

Key words: sarcoidosis, minimal change glomerulopathy, glucocorticoids

中图分类号:

R593.9

于柏松, 董春霞, 胡志娟, 刘冰. 结节病合并肾小球微小病变1例并文献复习[J]. 临床荟萃, 2026, 41(5): 452-456.

Yu Baisong, Dong Chunxia, Hu Zhijuan, Liu Bing. Sarcoidosis complicated by minimal change glomerulopathy: A case report and literature review[J]. Clinical Focus, 2026, 41(5): 452-456.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.05.010

https://www.lchc.cn/CN/Y2026/V41/I5/452

图/表 4

图1 肺结节病理学表现 a.左肺上叶结节;b.右肺下叶结节

Fig.1 Histopathological findings of the lung nodules a. Nodule in the upper lobe of the left lung; b. Nodule in the lower lobe of the right lung

图2 肺部CT a.2024年3月;b. 2024年8月

Fig.2 Chest CT a.March 2024; b.August 2024

图3 肾活检免疫荧光 a.免疫球蛋白G阴性;b.纤维蛋白原阴性

Fig.3 Renal biopsy immunofluorescence a. Immunoglobulin G negative; b.Fibrinogen negative

图4 肾活检光镜 a.过碘酸雪夫染色;b.过碘酸雪夫染色/马松三色染色

Fig.4 Renal biopsy light microscopy a. Periodic acid-Schiff staining; b. Periodic acid-Schiff/ Masson trichrome staining

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