感染性心内膜炎、急性肾损伤伴PR3-ANCA阳性患者1例报道

doi:10.6040/j.issn.1671-7554.0.2021.0836

摘要/Abstract

摘要： 目的探讨急性肾损伤和感染性心内膜炎伴PR3-ANCA阳性患者的临床特点,增加对该疾病的认识,减少误诊,为治疗提供线索。方法报道2017年2月18日就诊于山东大学齐鲁医院的急性肾损害患者1例,在行超声心动图检查时发现感染性心内膜炎伴赘生物,同时PR3-ANCA阳性,分析临床表现、实验室检查、治疗经过和随访预后。结果该患者心外科行手术治疗联合积极的抗感染治疗后,肾功能恢复良好。结论抗感染治疗对于感染性心内膜炎引起的肾脏损害是最基本的治疗。对于发热伴急性肾功能损害、ANCA阳性,主要表现为血尿、蛋白尿、补体下降的青年患者除考虑血管炎之外,也应注意筛查感染性心内膜炎的可能。

关键词: 急性肾损伤, 感染性心内膜炎, 抗中性粒细胞胞浆抗体, 抗生素, 糖皮质激素

Abstract: Objective To explore the clinical characteristics of infective endocarditis and acute kidney injury with positive PR3-ANCA, so as to improve the understanding of this disease, reduce misdiagnosis, and provide clues for treatment. Methods A case of acute kidney injury admitted to Qilu Hospital of Shandong University on February 18, 2017 was reported. Infectious endocarditis with neoplasms and positive PR3-ANCA were detected during echocardiography. Clinical manifestations, laboratory examination, treatment, follow-up and prognosis were analyzed. Results The patients renal function recovered well after cardiac surgery combined with aggressive anti-infective therapy. Conclusion Anti-infective treatment is the most basic treatment for kidney injury caused by infective endocarditis. For ANCA positive young patients with fever, acute renal injury with hematuria, proteinuria and decreased complements, the possibility of vasculitis as well as infective endocarditis should be considered.

Key words: Acute kidney injury, Infective endocarditis, Anti-neutrophil cytoplasmic antibody, Antibiotics, Glucocorticoid

中图分类号:

R542

王洲洋,江蓓,李宪花,甄军晖,杨向东,胡昭,刘广义,裴斐. 感染性心内膜炎、急性肾损伤伴PR3-ANCA阳性患者1例报道[J]. 山东大学学报 (医学版), 2022, 60(2): 60-64.

WANG Zhouyang, JIANG Bei, LI Xianhua, ZHEN Junhui, YANG Xiangdong, HU Zhao, LIU Guangyi, PEI Fei. A case of infective endocarditis and acute kidney injury with positive PR3-ANCA[J]. Journal of Shandong University (Health Sciences), 2022, 60(2): 60-64.

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