肝吸虫感染诱发PLA2R阳性膜性肾病活动及蛋白尿显著增高一例

A Case of PLA2R-Positive Membranous Nephropathy Exacerbation with Marked Proteinuria Elevation Induced by Liver Fluke Infection

摘要: 文章报告一例具有20余年病史的原发性膜性肾病(PLA2R阳性)患者，在病情长期相对稳定后，近期因新发严重蛋白尿(24小时尿蛋白定量 > 4.5 g)入院。常规粪便检查意外发现中华肝吸虫虫卵。在排除其他活动性诱因后，临床考虑此次膜性肾病(MN)的显著活动与肝吸虫感染相关。经口服阿苯达唑驱虫治疗，并强化肾病综合管理后，患者病情好转出院。本病例提示，在MN等免疫相关性肾病患者出现无法用原发病解释的病情活动时，需积极筛查隐匿性感染，特别是流行病区常见的寄生虫感染。肝吸虫感染可能通过激活机体异常免疫应答，诱发或加重MN，早期识别与针对性治疗对控制肾病活动至关重要。

Abstract: This report describes a case of primary membranous nephropathy (PLA2R-positive) with a history of over two decades, which presented with a recent onset of severe proteinuria (24-hour urine protein quantification > 4.5 g) despite long-term relative clinical stability. Routine stool examination unexpectedly revealed the presence of Clonorchis sinensis ova. After excluding other active triggering factors, the significant disease activity in membranous nephropathy (MN) was clinically attributed to the liver fluke infection. The patient was treated with oral albendazole for deworming, alongside intensified comprehensive nephropathy management, leading to clinical improvement and subsequent discharge. This case underscores the necessity of actively screening for occult infections, particularly parasitic infections endemic to the region, in patients with immunologically mediated kidney diseases such as MN when unexplained disease activity occurs. Liver fluke infection may potentially trigger or exacerbate MN by activating abnormal immune responses. Early recognition and targeted intervention are thus critical for controlling disease activity in nephropathy.