急性腎盂腎炎の合併が疑われた急速進行性糸球体腎炎

A case of rapidly progressive glomerulonephritis complicated with acute pyelonephritis

　73歳，男性。高熱，血膿尿の主訴で急性腎盂腎炎が疑われたが，検査の結果腎機能障害，尿沈渣上大小不同赤血球，顆粒円柱を認めた。急速進行性糸球体腎炎と判明し，治療により解熱したが腎機能は悪化し，維持透析となった。尿路閉塞などに合併しない腎盂腎炎では急性腎不全に至ることは稀で，特に尿沈渣で病的円柱などを伴う場合は早期に急速進行性糸球体腎炎を疑う必要があると考えられた。

　A 73-year-old man who complained of high grade fever and hematopyuria was referred to our hospital with suspicion of acute pyelonephritis. Blood test and urinalysis revealed acute renal failure showing azotemia and urinary dysmorphic red cells and granular casts. In spite of alleviation of fever by antibiotics,renal function was not improved. Complication of rapidly progressive glomerulonephritis was suspected,and was confirmed by the positive reaction of anti-glomerular basement membrane（anti-GBM）antibodies. Acute renal failure is a rare complication of acute pyelonephritis in patients without urinary obstruction,and the patients whose laboratory findings reveal acute renal failure with urinary casts should be suspected of rapidly progressive glomerulonephritis as soon as possible.