Riley Angela M, Wall Barry M, Cooke C Robert
Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee 38103, USA.
Am J Med Sci. 2009 Mar;337(3):221-3. doi: 10.1097/MAJ.0b013e318184a4a1.
IgA immune complex deposition is not commonly seen with acute postinfectious glomerulonephritis secondary to staphylococcal infections. Its deposition is usually indicative of IgA nephropathy or Henoch-Schonlein purpura nephritis. We describe a patient with a history of diabetes mellitus who was admitted with methicillin resistant Staphylococcus aureus bacteremia and subsequent demonstration on renal biopsy of crescentic glomerulonephritis associated with codominant IgA and C3 immune deposits and early changes of diabetic nephropathy. After aggressive treatment of infection, which included bilateral metatarsal amputation and subsequent left below-the-knee amputation as well as antibiotic administration for persistent osteomyelitis, the patient's renal function progressively improved with a reduction in serum creatinine concentration from 6.1 mg/dL (539 micromol/L) to 2.7 mg/dL (239 micromol/L). On a 3-year follow-up evaluation, his serum creatinine concentration was 1.7 mg/dL (150 micromol/L) and urine was negative for protein and blood.
IgA免疫复合物沉积在继发于葡萄球菌感染的急性感染后肾小球肾炎中并不常见。其沉积通常提示IgA肾病或过敏性紫癜性肾炎。我们描述了一名有糖尿病病史的患者，因耐甲氧西林金黄色葡萄球菌菌血症入院，随后肾活检显示为新月体性肾小球肾炎，伴有共显性IgA和C3免疫沉积物以及糖尿病肾病的早期改变。在积极抗感染治疗后，包括双侧跖骨截肢及随后的左膝下截肢以及针对持续性骨髓炎给予抗生素治疗，患者的肾功能逐渐改善，血清肌酐浓度从6.1mg/dL（539μmol/L）降至2.7mg/dL（239μmol/L）。在3年的随访评估中，他的血清肌酐浓度为1.7mg/dL（150μmol/L），尿蛋白和血尿均为阴性。
