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62岁男性,临床表现肾病综合征伴大量镜下血尿,血清肌酐升高、贫血、高黏质血症、血栓形成、冷球蛋白及免疫球蛋白IgM显著升高,血清免疫固定电泳可见κ型IgM条带。骨髓病理提示小淋巴细胞增生;肾活检病理诊断为冷球蛋白血症肾损害。行肾活检穿刺后患者血红蛋白进行性下降,B超见右肾下极旁108 mm×76 mm的血肿,行数字减影血管造影检查后立即床旁连续性静脉-静脉血液透析(CVVHD)治疗,即刻出现滤器前压升高,考虑高冷球蛋白堵塞滤器,予动脉端血液及透析液加温后,治疗得以继续,在行2次CVVHD治疗后,患者肾功能稳定,最终摆脱血液净化治疗。
62-year-old man with clinical manifestations of nephrotic syndrome with a large number of microscopic hematuria, elevated serum creatinine, anemia, hyperlipidemia, thrombosis, cryoglobulins and immunoglobulin IgM significantly increased serum immunostaining electrophoresis kappa type IgM band. Bone marrow pathology prompted small lymphocytic hyperplasia; renal biopsy pathology diagnosis of cryoglobulinemia kidney damage. Patients underwent renal biopsy after hemoglobin decreased, B ultrasound see the right lower renal artery 108cm × 76mm next to the hematoma, digital subtraction angiography immediately after bedside continuous venovenous hemodialysis (CVVHD) treatment, Immediately before the filter pressure increased, consider the high cryoglobuline blocking filter, to the arterial side of the blood and dialysate warming, the treatment continued to be in the line of 2 CVVHD treatment, the patients with stable renal function, and ultimately get rid of blood purification treatment.