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[1]金英,张炯,程震,等.硫普罗宁相关肾损害的临床病理特征并文献复习[J].医学研究与战创伤救治(原医学研究生学报),2020,22(3):239-244.[doi:10.3969/j.issn.1672-271X.2020.03.004]
　JIN Ying,ZHANG Jiong,CHENG Zhen,et al.The clinical and pathological characteristics of tiopronin-induced nephropathy：a case report and literature review[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(3):239-244.[doi:10.3969/j.issn.1672-271X.2020.03.004]
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硫普罗宁相关肾损害的临床病理特征并文献复习()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年3期
页码:
239-244
栏目:
临床研究
出版日期:
2020-05-15

文章信息/Info

Title:
The clinical and pathological characteristics of tiopronin-induced nephropathy：a case report and literature review
作者:
金英; 张炯; 程震; 王金泉
作者单位：210002南京，南京大学医学院附属金陵医院(东部战区总医院) 国家肾脏疾病临床医学研究中心 全军肾脏病研究所（金英、张炯、程震、王金泉）
Author(s):
JIN Ying;  ZHANG Jiong;  CHENG Zhen; WANG Jin-quan
(National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu, China)
关键词:
硫普罗宁; 蛋白尿; 膜性肾病
Keywords:
tiopronin; proteinuria; membranous nephropathy
分类号:
R4
DOI:
10.3969/j.issn.1672-271X.2020.03.004
文献标志码:
A
摘要:
目的分析硫普罗宁相关肾损害的临床病理特征，提高对硫普罗宁相关肾损害诊断的治疗水平。方法报道东部战区总医院收治的1例硫普罗宁导致膜性肾病的临床表现、病理改变及治疗预后，并收集自1979年至2020年2月所有硫普罗宁相关肾损害文献报道，分析其肾损害的临床病理特点及预后。结果此例患者临床表现为中等量蛋白尿（1.02~1.3 g/24 h），肾活检为肾小球膜性病变，停药后1个月尿蛋白部分缓解，8个月后完全缓解。包括文中病例在内，文献报道硫普罗宁致肾病综合征/蛋白尿共55例，其中12例患者表现为非综合征范围蛋白尿，43例表现为肾病综合征，有4例合并急性肾损伤。17例接受肾活检，其中膜性肾病9例，微小病变肾病5例，肾小球系膜增生性病变1例，局灶节段性肾小球硬化1例，膜增生性肾小球肾炎1例。33例预后数据不详，余22例数据齐全的患者均于停药后完全缓解。结论硫普罗宁可导致不同程度的蛋白尿，病理改变以肾小球足细胞病变为主，以膜性肾病为最常见表现，停药可缓解。及时诊断，可避免不必要的免疫抑制剂治疗。
Abstract:
ObjectiveTo analyze the clinical and pathological features of tiopronin associated membranous nephropathy (TMN) and enhance the understanding and early diagnosis of TMN.MethodsWe reported a case of membranous nephropathy caused by tiopronin. The clinicopathological features and prognosis of tiopronin-induced renal injury were summarized through literature reviewed from 1979 to February 2020.ResultsOur patient suffered moderate proteinuria (range from 1.02 to 1.3 g/24 h). The result of histology was membranous nephropathy. The poteinuria was partially relieved one month after the discontinuation of tiopronin, which was completely relieved eight months later. 55 cases of nephrotic syndrome or proteinuria caused by tiopronin were reported. A total of 12 patients presented with non syndromicproteinuria, 43 with nephrotic syndrome, 4 with acute renal injury. 17 patients received renal biopsy, including 9 cases of membranous nephropathy, 1 case of mesangioprolipherative glomerulonephritis，1 case of membranousprolipherative glomerulonephritis, 1 case of focal segmental glomurular sclerosis, and 5 cases of minimal change disease. 22 of 55 cases were completely relieved after tiopronin withdrawal. The prognosis of the rest 33 cases cannot be estimated due to incomplete data. ConclusionTiopronin can induce different levels of proteinuria. Podocyte injury is the major renal pathology manifestation. And the most common characteristic is membranous nephropathy. Most of those patients can be relieved after drug withdrawal. It should be diagnosed as early as possible to avoid the use of immunosuppressants.

参考文献/References:

[1]Pasero G, Ciompi ML. Thiopronine therapy in rheumatoid arthritis[J]. Arthritis Rheum，1979, 22(7):803-804.
[2]Rizzoni G, Pavanello L, Dussini N, et al. Nephrotic syndrome during treatment with alpha-mercaptopropionylglycine[J]. J Urol，1979, 122(3):381-382.
[3]Dubois A, Blotman F, Combe B. Nephrotic syndrome and renal failure induced by tiopronin in patients with rheumatoid arthritis[J]. J Rheumatol，1997, 24(10):2053-2054.
[4]邹杰, 赵会茹. 凯西莱致肾病综合征并急性肾衰临床报道1例[J].中华实用中西医杂志,2003,16(7)：932.
[5]张敏, 李长春. 硫普罗宁肠溶片致肾病综合征一例[J].肝脏,2006,11(4):255.
[6]穆立芹, 李明明. 硫普罗宁致肾病综合征1例[J].临床荟萃,2007,20(6):443.
[7]李敏侠, 邱强, 魏日胞, 等. 硫普罗宁致肾病综合征的报告分析[J].中国药物应用与监测,2012,9(2):100-102.
[8]张立欣, 牛凯. 硫普罗宁致肾病综合征[J].药物不良反应杂志,2019,21(1):61-62.
[9]Lindell A, Denneberg T, Enestrom S,et al. Membranous glomerulonephritis induced by 2-mercaptopropionylglycine (2-MPG)[J]. Clin Nephrol，1990, 34(3):108-115.
[10]Ferraccioli GF, Peri F, Nervetti A, et al. Tiopronin-nephropathy: clinical, pathological, immunological and immunogenetic characteristics[J]. Clin Exp Rheumatol，1986, 4(1):9-15.
[11]Shibasaki T, Murai S, Kodama K, et al. A case of nephrotic syndrome due to alpha-mercaptopropionyl glycine in a patient with familial cystinuria[J]. Nihon Jinzo Gakkai Shi，1990, 32(8):933-937.
[12]Zheng Z, Xue Y, Jia J,et al. Tiopronin-induced membranous nephropathy: a case report[J]. Ren Fail，2014, 36(9):1455-1460.
[13]Salvarani C, Macchioni P, Rossi F, et al. Nephrotic syndrome induced by tiopronin: association with the HLA-DR3 antigen[J]. Arthritis Rheum，1985, 28(5):595-596.
[14]Reveillaud RJ, Blanc G, Daudon M. Nephrotic syndrome and skin disorders appearing during alpha-mercapto-propionyl-glycine treatment of 2 cases of cystinic lithiasis[J]. J Urol Nephrol (Paris)，1978, 84(9):663-667.
[15]Pavanello L, Rizzoni G, Dussini N, et al. Cystinuria in children[J]. Eur Urol，1981, 7(3):139-143.
[16]Ambanelli U, Manganelli P, Ferraccioli GF. Clinical efficacy and adverse effects of tiopronin in rheumatoid arthritis. Report of a follow-up in 50 patients[J]. Z Rheumatol，1982, 41(5):235-239.
[17]Mordini M, Guidoni G, Maestrini M, et al.Basic treatment of rheumatoid arthritis with tiopronin. A study of 25 cases[J]. Minerva Med，1989, 80(9):1019-1023.
[18]Sany J, Combe B, Verdie-Petibon D, et al. Long-term tolerability of tiopronin (Acadione) in the treatment of rheumatoid arthritis. Apropos of 140 personal cases[J]. Rev Rhum Mal Osteoartic，1990, 57(2):105-111.
[19]Koeger AC, Palazzo E, De Person JF, et al. Subacute development of nephrotic syndrome caused by tiopronin therapy. A propos of 4 cases[J]. Rev Rhum Ed Fr，1993, 60(1):78.
[20]Asanuma H, Nakai H, Takeda M, et al. Clinical study on cystinuria in children--the stone management and the prevention of calculi recurrence[J]. Nihon Hinyokika Gakkai Zasshi，1998, 89(9):758-765.
[21]Lecoules S, Duvic C, Herody M, et al. Tiopronin-induced nephrotic syndrome with minimal glomerular lesions[J]. Presse Med，1999, 28(6):273-275.
[22]Alvarez Navascues R, Vidau Arguelles P, Rodriguez Suarez C, et al. Nephrotic syndrome and anasarca status, secondary to treatment with tiopronin in a case of cystinuria[J]. Arch Esp Urol，2001, 54(5):438-440.
[23]Tasic V, Lozanovski VJ, Ristoska-Bojkovska N,et al. Nephrotic syndrome occurring during tiopronin treatment for cystinuria[J]. Eur J Pediatr，2011, 170(2):247-249.
[24]Aksoy OY, Cakar N. Nephrotic syndrome in a patient with cystinuria: Answers[J]. Pediatr Nephrol，2019. doi: 10.1007/s00467-019-04440-2.
[25]Zhong H, Wang L, Gu ZC, et al. Minimal change disease induced by tiopronin: a rare case report and a review of the literature[J]. Ann Transl Med，2019, 7(16):398.
[26]许秀华,许树根,梁萌,等.肾小球PLA2R 检测在膜性肾病诊断中的应用[J].东南国防医药,2017,19(3)：254-257.
[27]Burbelo PD, Joshi M, Chaturvedi A, et al. Detection of PLA2R Autoantibodies before the Diagnosis of Membranous Nephropathy[J]. J Am Soc Nephrol，2020, 31(1):208-217.
[28]Godel M, Grahammer F, Huber TB. Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy[J]. N Engl J Med，2015, 372(11):1073.
[29]Sethi S, Debiec H, Madden B, et al. Neural epidermal growth factor-like 1 protein (NELL-1) associated membranous nephropathy[J]. Kidney Int，2020, 97(1):163-174.
[30]Ohtani H, Wakui H, Komatsuda A, et al. Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy[J]. Nephrol Dial Transplant，2004, 19(3):574-579.
[31]Lnnbro-Widgren J, Ebefors K, Mlne J, et al. Glomerular IgG subclasses in idiopathic and malignancy-associated membranous nephropathy[J]. Clin Kidney J，2015, 8(4):433-439.
[32]Polanco N, Gutierrez E, Covarsi A, et al. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy[J]. J Am Soc Nephrol，2010, 21(4):697-704.
[33]Hogan JJ, Markowitz GS, Radhakrishnan J. Drug-induced glomerular disease: immune-mediated injury[J]. Clin J Am Soc Nephrol，2015, 10(7):1300-1310.
[34]Sakashita K, Murata K, Takahashi Y, et al. A Case Series of Acute Kidney Injury During Anti-tuberculosis Treatment[J]. Intern Med, 2019, 58(4):521-527.
[35]Kohno K, Mizuta Y, Yoshida T, et al. Minimal change nephrotic syndrome associated with rifampicin treatment[J]. Nephrol Dial Transplant 2000, 15(7):1056-1059.
[36]Mori S, Matsushita Y, Arizono K. Minimal-change nephrotic syndrome associated with isoniazid in anti-tuberculosis chemoprophylaxis for a patient with rheumatoid arthritis[J]. Intern Med, 2011, 50(3):253-257.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81470944）
更新日期/Last Update: 2020-05-15