Lim B J, Suh K S, Na K R, Lee K W, Shin Y T
Department of Pathology, Lancer Research Institute, Chungnam National University College of Medicine, Moonhwa-dong, Jung-gu, Daejeon, Korea.
Clin Nephrol. 2008 Aug;70(2):155-8. doi: 10.5414/cnp70155.
Superimposition of poststreptococcal glomerulonephritis (PSGN) on the course of IgA nephropathy (IgAN) is uncommon. A case of PSGN during IgA nephropathy is presented. A 30-year-old man who had alternating gross and microscopic hematuria for 7 months underwent a renal biopsy. The first renal biopsy revealed IgAN with mesangial deposits of IgA and C3. Two months later, the patient suffered generalized edema, proteinuria, hematuria, an increased ASO titer and a decreased C3 level. A second renal biopsy revealed diffuse endocapillary proliferative glomerulonephritis with epimembranous hump-like electron-dense deposits of C3, but the original mesangial IgA deposits had disappeared. A diagnosis of acute PSGN was indicated. Two months after the onset of acute nephritic syndrome, the patient remained asymptomatic, except for microscopic hematuria and proteinuria. Some cases with persistent proteinuria or hematuria after PSGN are probably related to preexisting IgAN.
链球菌感染后肾小球肾炎（PSGN）叠加于IgA肾病（IgAN）病程的情况并不常见。本文报告1例IgA肾病合并PSGN的病例。一名30岁男性，反复肉眼血尿和镜下血尿7个月，接受了肾活检。首次肾活检显示为IgA肾病，伴有IgA和C3的系膜沉积。两个月后，患者出现全身水肿、蛋白尿、血尿、抗链球菌溶血素O（ASO）滴度升高和C3水平降低。第二次肾活检显示弥漫性毛细血管内增生性肾小球肾炎，伴有C3的膜上皮驼峰样电子致密沉积物，但原来的系膜IgA沉积物已消失。提示诊断为急性PSGN。急性肾炎综合征发病两个月后，除镜下血尿和蛋白尿外，患者无其他症状。PSGN后仍有持续性蛋白尿或血尿的一些病例可能与先前存在的IgA肾病有关。
