Hiki Y, Tamura K, Shigematsu H, Kobayashi Y
Department of Medicine, School of Nursing and Medicine, Kitasato University, Sagamihara, Japan.
Nephron. 1991;57(3):358-64. doi: 10.1159/000186288.
A 17-year-old male with poststreptococcal acute glomerulonephritis (PSAGN) superimposed on the course of IgA nephropathy is presented. The histological findings of the first renal biopsy showed mild IgA nephropathy with a mesangial deposition of IgA and C3. Eighteen months later, acute nephritic syndrome with hypocomplementemia and rising antihyaluronidase titer occurred 10 days following the onset of an upper respiratory infection. The second renal biopsy revealed severe diffuse endocapillary proliferative and exudative glomerulonephritis with cellular crescents in 70% of the glomeruli. Immunofluorescence showed granular staining of C3 alone along the capillary walls. The pre-existing IgA deposits had disappeared. Typical 'humps' were observed by electron microscopy. The symptoms were gradually resolved by intensive steroid and anticoagulant therapy. Five months after the episode of acute nephritic syndrome, the patient was clear of symptoms except for mild proteinuria and hematuria. The third renal biopsy at that time showed morphologic changes similar to those of the first renal biopsy with mild mesangial IgA deposits.
本文报告了一名17岁男性，其在IgA肾病病程中并发了链球菌感染后急性肾小球肾炎（PSAGN）。首次肾活检的组织学结果显示为轻度IgA肾病，IgA和C3在系膜区沉积。18个月后，在上呼吸道感染发作10天后出现了伴有低补体血症和抗透明质酸酶滴度升高的急性肾炎综合征。第二次肾活检显示严重的弥漫性毛细血管内增生性和渗出性肾小球肾炎，70%的肾小球有细胞性新月体形成。免疫荧光显示仅C3沿毛细血管壁呈颗粒状染色。先前存在的IgA沉积物已消失。电镜观察到典型的“驼峰”。通过强化类固醇和抗凝治疗，症状逐渐缓解。急性肾炎综合征发作5个月后，除轻度蛋白尿和血尿外，患者症状消失。当时的第三次肾活检显示形态学改变与首次肾活检相似，有轻度系膜IgA沉积。
