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NEJM：黄色肉芽肿肾盂肾炎-病例报道

2018-03-08 xing.T MedSci原创

黄色肉芽肿肾盂肾炎发热昏睡
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黄色肉芽肿肾盂肾炎是慢性肾盂肾炎的一种形式，通常与梗阻性结石及复发性尿路感染相关。可能的并发症包括脓肿和瘘。肾功能丧失较为常见，肾脏切除术是根治性的治疗。该患者术后5天出院，随访1个月，肾功能稳定。

患者为一名73岁的女性，因发热和昏睡10天而到急诊就诊。她既往有2型糖尿病、反复尿路感染和体重减轻约13.5公斤。

实验室研究显示白细胞计数为14290每立方毫米（参考范围4500至11000）和血清肌酐水平为1.3mg/dL（115μmol/dL；参考范围为0.6到1.5mg/dL [ 53-133μmol/dL]）；对尿沉渣检查发现每高倍镜视野有50-100个白细胞，但细菌培养阴性。静脉注射造影剂进行腹部CT扫描（如图A）显示右肾扩大，肾盂输尿管连接处可见鹿角形结石，皮质萎缩，肾盏扩张的外观被称为“熊掌征”。



开始静脉注射抗生素，并进行经皮肾穿刺造瘘术。对排出的尿液进行培养得到奇异变形杆菌。经过放射性核素扫描显示右侧肾功能缺失，切除肾脏。病理分析显示，鹿角形结石（如图B箭头所示），扩张肾盏，囊腔和黄色的组织。组织学检查显示纤维化和慢性肉芽肿性炎症浸润，充满脂质的泡沫巨噬细胞和坏死碎片。被确诊为黄色肉芽肿肾盂肾炎。

黄色肉芽肿肾盂肾炎是慢性肾盂肾炎的一种形式，通常与梗阻性结石及复发性尿路感染相关。可能的并发症包括脓肿和瘘。肾功能丧失较为常见，肾脏切除术是根治性的治疗。该患者术后5天出院，随访1个月，肾功能稳定。

原始出处：

Lucas X. Marinacci,et al. Xanthogranulomatous Pyelonephritis.N Engl J Med 2018.http://www.nejm.org/doi/full/10.1056/NEJMicm1710400

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    2018-03-09 12498f1em08(暂无昵称)

    #肉芽肿#

    0

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    2018-03-09 villahu

    #肾炎#

    0

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    2018-03-08 大爰

    学习了谢谢分享!!

    0

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    2018-03-08 龙胆草

    学习谢谢分享

    0

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    2018-03-08 121d7bbfm89暂无昵称

    学习了.谢谢分享

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1344759, encodeId=7ada1344e59b5, content=<a href='/topic/show?id=0e98808e9f9' target=_blank style='color:#2F92EE;'>#肉芽肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80879, encryptionId=0e98808e9f9, topicName=肉芽肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Fri Mar 09 22:46:00 CST 2018, time=2018-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1532248, encodeId=66a2153224805, content=<a href='/topic/show?id=10b5825e4aa' target=_blank style='color:#2F92EE;'>#肾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82574, encryptionId=10b5825e4aa, topicName=肾炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84df12331144, createdName=villahu, createdTime=Fri Mar 09 22:46:00 CST 2018, time=2018-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294142, encodeId=f6f629414240, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Thu Mar 08 09:27:37 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294130, encodeId=b7d929413088, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Mar 08 08:52:48 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294128, encodeId=b95929412849, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=72be2286269, createdName=121d7bbfm89暂无昵称, createdTime=Thu Mar 08 08:26:06 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294120, encodeId=a9742941208a, content=好好好学习天天向上, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 08 08:01:20 CST 2018, time=2018-03-08, status=1, ipAttribution=)]
    2018-03-08 忠诚向上

    好好好学习天天向上

    0