One Case Report Of Chronic Renal Failure Due To Primary Sjogren's Syndrome And Literature Review

Objective: To analyze and summarize the characteristics,pathogenesis,clinicopathological manifestations and diagnosis and treatment of patients with primary Sjogren's syndrome renal impairment through a case analysis of a patient with chronic renal failure caused by primary Sjogren's syndrome Enhance the clinician's awareness and attention to renal damage of primary Sjogren's syndrome,improve the level of diagnosis and treatment,and reduce the rate of misdiagnosis and missed diagnosis.Methods: The clinical and pathological data of a patient with chronic renal failure due to primary Sjogren's syndrome were retrospectively analyzed.The prevalence,pathogenesis,and clinical characteristics of patients with primary Sjogren's syndrome with renal impairment were combined with relevant domestic and foreign literature.Pathological manifestations,diagnosis,and treatment were discussed,analyzed,and summarized.Results: A 38-year-old female patient,mainly due to dry mouth,dry eyes,increased nocturia with fatigue and low fever for 8 months,was found to be hospitalized with an increase in serum creatinine 5 days before the admission.Check urea 7.06 mmol / L and serum creatinine 140 umol / L,blood potassium 2.48 mmol / L,blood chlorine 122.4mmol / L,blood carbon dioxide binding force(TCO2)11.7mmol / L,anion gap(AG)11.9mmol / L,urine p H 7.0,urine protein 1+,CT prompt Microscopic stones in both kidneys,positive blood anti-SSA and anti-SSB antibodies after admission;biopsy of lower labial gland showed Sjogren's syndrome,Chisholm grade ?;pathological manifestation of renal tissue was interstitial multifocal fibrosis with mononuclear cells(with plasma The cells are mainly infiltrated,the renal tubular epithelial cells are multifocal atrophy,some of the lumen are compensated expansion,most of the glomerular mesangial cells and matrix are slightly segmental hyperplasia,immunofluorescence shows Ig G,Ig A,C3 in the system Membrane area and capillary loop deposition;diagnosed with primary Sjogren's syndrome renal damage,given to patients with methylprednisolone combined with hydroxychloroquine,while actively correcting symptomatic treatment such as electrolyte acid-base balance disorders,the patient's blood creatinine decreased to a certain extent,low potassium He was discharged from the hospital after his blood and acidosis were corrected.The patient was followed up for more than 6 months after discharge from the hospital.After treatment with prednisone acetate and cyclophosphamide,the serum creatinine fluctuated between 99.89-115.46 umol / L,and the blood potassium,blood chloride,and TCO2 were all checked in the normal range.Diagnosis: 1.Chronic renal failure,primary Sjogren's syndrome,renal damage,type ? renal tubular acidosis,and both kidney microscopic stones.2.Primary Sjogren's syndrome.Conclusion:Primary Sjogren's syndrome is more common and is mainly female.The most common clinical manifestations are renal tubular acidosis and renal tubular concentrating dysfunction,which can be manifested as normal anion-gap hyperchloremic metabolism.Acidosis,hypokalemia,urinary stones,polydipsia,polyuria,increased nocturia,etc.In addition,proteinuria and elevated serum creatinine are more common in newly diagnosed patients.The pathological characteristics of p SS renal damage are mainly multifocal infiltration of lymphocytes,plasma cells,and monocytes in the renal interstitial to varying degrees,resulting in varying degrees of tubular epithelial cell destruction and renal interstitial fibrosis.The pathological type is chronic intertubular It is most common for qualitative nephritis or glomerulopathy.Glomerular lesions are mainly characterized by proliferative lesions of different degrees in the mesangial area,and immunofluorescence is mainly Ig G,Ig A,and C3 deposition in the mesangial area and capillary loops.Treatment of renal damage in primary Sjogren's syndrome is mainly glucocorticoids and / or cytotoxic drugs.Most patients can be corrected for renal tubular acidosis and hypokalemia after treatment,and renal function can be restored to a certain extent and can be Maintaining stability for a long time,early detection,early diagnosis,and early treatment are important measures to avoid irreversible renal damage.