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肝豆状核变性合并薄基底膜肾病1 例报告并文献复习

  • 崔洁媛 ,
  •  张宏文
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  • 1 . 河北省儿童医院肾脏免疫科(河北石家庄 050031);2 . 北京大学第一医院儿科(北京 100034)

收稿日期: 2017-02-15

  网络出版日期: 2017-02-15

Childhood hepatolenticular degeneration combined with thin basement membrane nephropathy: a case report with literature review

  • Cui Jieyuan ,
  • Zhang Hongwen
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  • 1. Department of Nephrology and Immunology, Children’s Hospital of Heibei Province, Shijiazhuang 050031, Hebei, China; 2. Department of Pediatric, Peking University First Hospital, Beijing 100034, China

Received date: 2017-02-15

  Online published: 2017-02-15

摘要

 目的 分析儿童肝豆状核变性合并肾病的诊断。方法 回顾分析1例血尿伴肝功能异常、低补体血症,最终 确诊为肝豆状核变性合并薄基底膜肾病患儿的临床资料。结果 患儿,女,10岁。主要临床表现为持续镜下血尿,不伴白 蛋白尿,伴肝功能异常、低补体血症、近期构音异常;肾脏病理为薄基底膜肾病;血铜蓝蛋白23.10 mg/L,尿铜120 μg/24 h; 头颅MRI示双侧基底核及壳核异常信号;腹部超声提示肝硬化;眼裂隙灯双侧角膜可见K-F环;基因突变分析示患儿 ATP7B纯合突变,COL4A3杂合突变。结论 持续性镜下血尿伴肝功能异常、低补体血症者,临床需常规除外肝豆状核变 性之可能。

本文引用格式

崔洁媛 ,  张宏文 . 肝豆状核变性合并薄基底膜肾病1 例报告并文献复习[J]. 临床儿科杂志, 2017 , 35(2) : 118 . DOI: 10.3969/j.issn.1000-3606.2017.02.010

Abstract

 Objective To analyze the diagnostic approach on hepatolenticular degeneration combined with thin basement membrane nephropathy. Methods A girl presented with microscopic hematuria, liver dysfunction and hypocomplementemia was diagnosed with hepatolenticular degeneration combined with thin basement membrane nephropathy, her clinical data were summarized and analyzed retrospectively. Results A ten years old girl presented with microscopic hematuria and liver dysfunction for a year, dysarthria for a month, and combined with hypocomplementemia but without proteinuria. Renal biopsy showed thin basement membrane nephropathy. Ceruloplasmin was 23.10 mg/L and urinary copper concentration was 120μg, respectively,  ocular slit lamp examination showed Kayser-Fleischer ring, cranial MRI showed preternatural signal in both basal and putamen nucleus, mutation analysis showed homozygous mutations in ATP7B and heterozygous mutation in COL4A3 gene, respectively. Conclussion Hepatolenticular degeneration should be suspected in those cases with persistence microscopic hematuria, liver dysfunction and hypocomplementemia.
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