心筋炎後の急性心不全にネフローゼ症候群を合併した1例

Abstract

We reported a 32-year-old man presenting with acute heart failure associat- ed with nephrotic syndrome. Dyspnea on exertion and pretibial edema appeared 4 weeks after flu-like symptoms. Proteinuria was never pointed out before onset. Laboratory data on admission showed 7.4g/day of proteinuria, and hypoalbuminemia (2.97g/dl). Dilated cardial shadow and congestion were observed in chest roentgenogram. Endomyocardial biopsy revealed swelling of myocytes and interstitial fibrosis without inflammatory infil- trates, suggesting subsiding or healing stage of myocarditis. Renal biopsy specimen disclosed mild mesangial proliferative glomerulonephritis accompanied by IgA deposits. Thus the patient was diagnosed as having congestive heart failure due to myocarditis and IgA nephropathy. Clinical symptoms and cardiac shadow were improved by administration of digitalis and diuretics. In parallel with recovery of clinical symptoms, proteinuria was decreased in amount and reached to 0.3g/day. The clinical course suggested that latent IgA nephropathy was evoked by congestive heart failure and developed nephrotic syn- drome. Although proteinuria is not an uncommon findings in patients with congestive heart failure, proteinuria exceeding 1g/day or nephrotic syndrome is extremely rare. We discuss relationship between proteinuria and heart failure documented in the literature.