临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (3): 183-.doi: 10.3969/j.issn.1000-3606.2017.03.007

• 综合报道 • 上一篇    下一篇

儿童Kimura 病合并肾病综合征临床、病理及预后分析

李志娟1, 张小鸽2, 包瑛1, 陈国强2, 唐筠1, 黄惠梅1   

  1. 1 . 西安市儿童医院肾脏科(陕西西安 710003);2 . 陕西西北妇女儿童医院内三科(陕西西安 710061)
  • 收稿日期:2017-03-15 出版日期:2017-03-15 发布日期:2017-03-15
  • 通讯作者: 张小鸽 E-mail:zxge007@163 .com

The clinical feature, pathology, and prognosis of Kimura disease complicated with nephrotic syndrome in children 

LI Zhijuan1, ZHANG Xiaoge2, BAO Ying1, CHEN Guoqiang2, TANG Jun1, HUANG Huimei1   

  1. 1.Department of Nephrology, Xi’an  Children’s Hospital, Xi’an 710003, Shaanxi, China; 2.The Third Internal Medicine Ward, The Northwest Women and Children Hospital, Xi'an 710061, Shaanxi, China
  • Received:2017-03-15 Online:2017-03-15 Published:2017-03-15

摘要: 目的 探讨儿童Kimura病合并肾病综合征的临床特征。方法 回顾分析4例Kimura病合并肾病综合征患儿 的临床资料。结果 4例患儿均为男性,血清IgE均升高,外周血嗜酸性粒细胞均无升高;患儿的肾脏病理表现不一, 2例 出现急性肾小管损伤, 1例重复肾活检出现病理转型,另1例肾脏间质见少许嗜酸性粒细胞浸润。 4例患儿均对口服激素敏 感。但除1例随访时间短,尚未复发,另3例均有复发,且均表现为尿蛋白阳性,不伴随淋巴结肿大。 3例复发患儿加用免疫 抑制剂治疗,其中2例加用他克莫司,复发次数较前减少。结论 儿童Kimura病合并肾病综合征病程长,肾脏病理表现不 一,对激素敏感,但易复发,需联合免疫抑制剂治疗,他克莫司可能对减少复发、延缓肾脏病理进展有一定疗效。

Abstract:  Objective To explore the clinical feature of Kimura disease complicated with nephrotic syndrome in children. Methods The clinical data from 4 children with Kimura disease complicated with nephrotic syndrome were retrospectively analyzed. Results In all of the 4 male children, level of serum IgE was increased but level of eosinophils was not increased in peripheral blood. The renal pathological manifestations were different among them. Two cases had acute tubular injury, one case had pathological changes in repeated renal biopsy, and one case had a little of eosinophils infiltration in renal interstitium. All of them were sensitive to oral hormone treatment. Except that one case had no relapse yet in short follow-up period, the other 3 cases had relapsed and all manifested as positive urinary protein without lymphadenectasis. The 3 cases with recurrence were treated by combined immunosuppressive agents, the palindromia of two cases were reduced which were combined with tacrolimus. Conclusion The Kimura disease complicated with nephrotic syndrome in children has a long course and different renal pathological manifestations. It is sensitive to hormone treatment but easy to relapse, and the treatment should be combined with immunosuppressive therapy. Tacrolimus may have the effect on reducing relapse and delaying the progress of renal pathology.