Julian B A, Cannon V R, Waldo F B, Egido J
Department of Medicine, University of Alabama, Birmingham 35294.
Am J Kidney Dis. 1991 Apr;17(4):472-9. doi: 10.1016/s0272-6386(12)80643-3.
Although the clinical onset of IgA nephropathy is frequently impossible to define, macroscopic hematuria apparently heralds the onset of the disease in some patients. We describe the clinical course and renal histologic findings of four adults with IgA nephropathy who were diagnosed by the characteristic immunohistologic features in a second renal biopsy specimen. IgA was not detected in the initial renal biopsy specimens obtained 9 months to 4 years earlier. The first renal biopsy had been performed to evaluate macroscopic hematuria (recurrent in three patients), accompanied by pathologic proteinuria in two patients. Our observations suggest that the pathognomonic immunohistologic findings of IgA nephropathy may follow the clinical onset and raise questions about the presumed pathogenetic role of IgA in the early stages of this disease.
尽管IgA肾病的临床发病往往难以明确，但肉眼血尿显然在一些患者中预示着疾病的发作。我们描述了4例IgA肾病成年患者的临床病程和肾脏组织学表现，这些患者通过第二次肾活检标本中的特征性免疫组织学特征得以确诊。在9个月至4年前获取的初始肾活检标本中未检测到IgA。首次肾活检是为了评估肉眼血尿（3例患者为复发性），其中2例患者伴有病理性蛋白尿。我们的观察结果表明，IgA肾病的特征性免疫组织学表现可能在临床发病之后出现，并对IgA在该疾病早期阶段假定的致病作用提出了疑问。
