Kanno Toru, Ito Masaaki, Kawase Norio, Taki Yoji, Yoshida Hiroshi, Okuno Hiroshi, Ogawa Osamu
Department of Urology, Toyooka Public Hospital.
Hinyokika Kiyo. 2002 Jun;48(6):379-82.
A 39-year-old man who had been diagnosed with immunoglobulin A (IgA) nephropathy underwent renal transplant from his father. The operation was performed under cyclosporine, prednisolone and mizoribine treatment. Renal function was stable following transplantation, but proteinuria ranged between 1 g/day and 3 g/day. Protocol biopsy 1 year after transplantation revealed membranous glomerulonephritis, with IgG and C3 deposits under immunofluorescence, and subepithelial deposits detected on electron microscopy. The patient was treated by limiting protein intake, controlling blood pressure and administering candesartan. Proteinuria decreased from 5.6 g/day to 1 g/day, but a graft biopsy was performed 2 years after transplantation because of a slightly increasing creatinine level. There was no sign of rejection, and IgG and C3 deposits observed under immunofluorescence had decreased. After the graft biopsy, the creatinine level was stable and proteinuria decreased to 0.7 g/day. In conclusion, de novo nephropathy such as membranous glomerulonephritis should also be considered a possible cause of proteinuria following renal transplantation.
一名39岁被诊断为免疫球蛋白A（IgA）肾病的男子接受了来自其父亲的肾脏移植手术。手术在环孢素、泼尼松龙和米唑立宾治疗下进行。移植后肾功能稳定，但蛋白尿在每天1克至3克之间。移植后1年的常规活检显示为膜性肾小球肾炎，免疫荧光下有IgG和C3沉积，电子显微镜检查发现上皮下沉积物。患者通过限制蛋白质摄入、控制血压和服用坎地沙坦进行治疗。蛋白尿从每天5.6克降至每天1克，但由于肌酐水平略有升高，在移植后2年进行了移植肾活检。没有排斥迹象，免疫荧光下观察到的IgG和C3沉积减少。移植肾活检后，肌酐水平稳定，蛋白尿降至每天0.7克。总之，诸如膜性肾小球肾炎等新发肾病也应被视为肾移植后蛋白尿的可能原因。
