多发性骨髓瘤合并膜增生型C3肾小球肾炎一例
Chinese Journal of Nephrology(2013)
Abstract
患者,女,56岁,半年前无明显诱因出现双下肢水肿,当地医院予对症治疗(具体不详),疗效差.1周前水肿加重,以"肾病综合征"收入院."高血压史"1年.其母患"高血压病".查体:BP 180/90 mm Hg,贫血貌,双下肢水肿,余无异常.辅助检查:血常规RBC 2.16× 1012/L,Hb 70g/L;尿蛋白3+,RBC 20/HP,WBC 13/HP;24 h尿蛋白量2.384 g;血Ca 2.0 mmol/L,Scr 105 μmol/L,白蛋白26.6 g/L,球蛋白32.5 g/L,三酰甘油2.76 mmol/L,总胆固醇6.09mmol/L;ANA(±),ANCA(-),抗GBM(-);肾素-血管紧张素-醛同酮系统立卧位无异常;CRP 0.97 mg/L,IgG 16.89 g/L,IgA 0.74 g/L,IgM 9.64 g/L,IgE 31.50 g/L,C3 0.72 g/L,C40.15 g/L,ESR 119 mm/h;尿本周蛋白κ阳性;血清蛋白电泳:γ 30.6%;免疫同定电泳M蛋白IgG/κ型;彩超:左肾113 mm×52 mm×60 mm,厚19 mm,右肾111 mm×48 mm×61mm,厚13 mm,双侧肾动脉阻力指数增高.
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