PDF(Pubmed)
Abstract：
We report a case of a sudden onset of minimal change nephrotic syndrome (MCNS) in a 33-year-old woman with type 1 diabetes mellitus (T1DM), stable microalbuminuria, and chronic thyroiditis. She was successfully treated with intravenous corticosteroids to finally attain a complete remission. Four years later, she also experienced a relapse of MCNS in the same season as the first onset. The chronological levels of serum immunoglobulin E (IgE) showed that extremely high serum IgE levels preceded the onset or the relapse of MCNS, which may suggest an allergic mechanism of MCNS. Eicosapentaenoic acid (EPA) was reported to be beneficial in treating allergic diseases. Suplatast tosilate is an anti-allergic medication that suppresses serum IgE and was reported to be beneficial in reducing corticosteroid dose in nephrotic syndrome in a pilot study. Therefore, during the tapering of corticosteroids to the relapse of MCNS, suplatast tosilate and EPA were administered, and the IgE levels were considerably controlled. The patient was able to maintain remission even after the cessation of corticosteroids. In conclusion, suppressing IgE levels using suplatast tosilate and EPA may be beneficial in maintaining complete remission without corticosteroids in T1DM.
摘要：
我们报告了一例在一名33岁的1型糖尿病（T1DM）女性中突然发作的微小病变肾病综合征（MCNS）。稳定的微量白蛋白尿，和慢性甲状腺炎.她成功地用静脉注射皮质类固醇治疗，最终达到完全缓解。四年后,她在第一次发病的同一季节也经历了MCNS的复发.血清免疫球蛋白E（IgE）的时间顺序显示，极高的血清IgE水平先于MCNS的发作或复发，这可能提示MCNS的过敏机制。据报道，二十碳五烯酸（EPA）有益于治疗过敏性疾病。Suplatasttossilate是一种抗过敏药物，可抑制血清IgE，据报道在一项初步研究中有益于减少肾病综合征的皮质类固醇剂量。因此,在皮质类固醇逐渐减少到MCNS复发的过程中，给予甲苯磺酸盐和EPA，IgE水平得到相当大的控制。即使在停止皮质类固醇后，患者仍能够维持缓解。总之,在T1DM患者中,使用甲苯磺酸盐和EPA抑制IgE水平可能有助于维持完全缓解,而无需使用皮质类固醇。
