目的：探讨海洛因相关性肾病( heroin associated nephropathy, HAN)的临床特点及治疗体会,以减少误漏诊。方法回顾性分析我院近期收治的1例曾误诊为肾病综合征的HAN的临床资料。结果本例以全身水肿伴多浆膜腔积液起病,存在大量蛋白尿、低蛋白血症及高脂血症,外院诊断为肾病综合征,予相应治疗后水肿消退。入院前10 d患者再次出现尿量减少及水肿加重,入我院。有吸食海洛因史10余年,丙型肝炎史10余年。行肾穿刺活组织病理检查示肾小球局灶节段硬化性病变,免疫荧光试验全阴性,排除继发性肾脏疾病后诊断为HAN,予戒毒及抗病毒、足量糖皮质激素治疗,患者病情缓解。结论 HAN以肾病综合征为主要表现,病理检查表现为局灶节段肾小球硬化,尽早戒毒并联合应用糖皮质激素及抗病毒等综合治疗措施,可改善患者预后。%Objective To explore the clinic features and treatment of heroin associated nephropathy ( HAN) in order to reduce the rates of missed diagnosis and misdiagnosis. Methods The clinical data of one case with HAN, who was misdi-agnosed as having nephrotic syndrome, were retrospectively analyzed. Results A male patient had been admitted to another hospital for generalized edema and dropsy of serous cavity, and laboratory analysis revealed nephrotic proteinuria, hypo-albu-minemia, and hyperlipidemia. The patient was diagnosed as having nephritic syndrome. After symptomatic therapy, edema subsided. The patient was admitted to our hospital for a relapse of oliguria and edema for 10 days. The patient had a history of heroin abuse and chronic hepatitis C virus infection for more than 10 years. Pathological findings of the renal biopsy demon-strated Focal Segmental Glomerulosclerosis ( FSGS ) , and negative staining for immunoglobulin and C3 in immunofluores-cence. The possibility of secondary glomerular disease was excluded;the patient was diagnosed as having HAN. After the use of heroin was discontinued and treatment with antiviral agents and Glucocorticoids was applied, clinical status of the patient was improved. Conclusion Nephrotic syndrome is the main clinical manifestation of HAN, and the predominant pathologic lesion is FSGS. Combined therapy including discontinuation of the use of heroin as early as possible, and treatment with Glu-cocorticoids, and antiviral agents for hepatitis may improve the prognosis.
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