每日一题_2023.11.10

A 60-year-old woman with hypertension and chronic kidney disease of unknown cause was referred to the emergency department because of a serum creatinine level of 7.8 mg per deciliter (reference range, 0.5 to 0.9). She had been feeling well before presentation. A urinalysis showed 2+ protein and more than 180 red cells per high-power field with no urinary casts. On the basis of a positive indirect fluorescent antibody assay for anti-glomerular basement membrane (GBM) antibodies and a kidney biopsy showing crescentic glomerulonephritis (left) with strong linear GBM staining for IgG on immunofluorescence (right), a diagnosis of anti-GBM glomerulonephritis was made. Which additional diagnostic test is required to look for extra-renal involvement?

一名患不明原因高血压和慢性肾脏病的60岁女性因血清肌酐水平为7.8 mg / dl(参考范围，0.5 ~ 0.9 mg / dl)而被转诊到急诊科。患者在就诊前一直感觉良好。尿液分析显示蛋白2+，红细胞超过180个/高倍视野，无尿管。根据间接荧光抗体检测抗肾小球基底膜(GBM)抗体阳性，以及肾活检显示新月体性肾小球肾炎(左)和免疫荧光IgG强线性GBM染色(右)，我们做出了抗GBM肾小球肾炎的诊断。还需要哪些额外的诊断性检查来寻找肾外受累?

A. Chest imaging 胸部影像学检查

B. Echocardiogram 超声心动图

C. Ophthalmologic exam 眼科检查

D. Otorhinolaryngology evaluation 耳鼻咽喉科评估

E. Skin biopsy 皮肤活检

答案解析：

正确答案是胸部影像学检查。虽然该患者仅有肾脏受累，但抗gbm病可累及肾脏和肺。需要胸部x线摄影或计算机断层扫描来评估抗gbm病的肺部受累情况。血浆置换、糖皮质激素和环磷酰胺治疗使患者的抗gbm抗体水平在血浆置换第3日时不可测，但6个月后患者仍然依赖透析。

正确答案：A