感染后 IgA 主导性肾小球肾炎与特发性 IgA 肾病的鉴别诊断。

Discrimination between postinfectious IgA-dominant glomerulonephritis and idiopathic IgA nephropathy.

机构信息

Division of Nephrology, Changhua Christian Medical Center, Changhua, Taiwan, Republic of China.

出版信息

Ren Fail. 2010 Jun;32(5):572-7. doi: 10.3109/08860221003753331.

DOI:10.3109/08860221003753331

PMID:20486840

Abstract

BACKGROUND

A unique form of postinfectious glomerulonephritis (PIGN) with IgA-dominant deposition mimicking IgA nephropathy has been increasingly reported.

METHODS

We compared the clinical and histological features of 12 patients with postinfectious IgA-dominant glomerulonephritis to 134 patients with idiopathic IgA nephropathy.

RESULTS

In addition to hypocomplementemia and subepithelial hump-shaped deposits characteristic of PIGN, patients with postinfectious IgA-dominant glomerulonephritis had older age (62.3 +/- 16.9 vs. 37.9 +/- 16.3 years; p < 0.001) and more frequently presented with acute renal failure (83.3% vs. 10.4%; p < 0.001) than patients with idiopathic IgA nephropathy. Moreover, glomerular changes including endocapillary proliferation, neutrophil infiltration, and capillary loops deposits by immunofluorescence were more commonly present in postinfectious IgA-dominant glomerulonephritis group (p < 0.001).

CONCLUSIONS

PIGN could be characterized by glomerular IgA-dominant deposition resembling idiopathic IgA nephropathy. It is essential to differentiate postinfectious IgA-dominant glomerulonephritis from idiopathic IgA nephropathy because of the different treatments and prognosis of the two diseases.

摘要

背景

越来越多的报道表明，有一种独特形式的感染后肾小球肾炎（PIGN），其免疫球蛋白 A（IgA）沉积为主，类似于 IgA 肾病。

方法

我们比较了 12 例感染后 IgA 主导型肾小球肾炎患者与 134 例特发性 IgA 肾病患者的临床和组织学特征。

结果

除了 PIGN 特有的低补体血症和上皮下驼峰状沉积物外，感染后 IgA 主导型肾小球肾炎患者的年龄更大（62.3 ± 16.9 岁 vs. 37.9 ± 16.3 岁；p < 0.001），更常出现急性肾衰竭（83.3% vs. 10.4%；p < 0.001）。此外，感染后 IgA 主导型肾小球肾炎患者的肾小球变化更常见，包括内皮下增殖、中性粒细胞浸润和免疫荧光显示的毛细血管袢沉积物（p < 0.001）。