Clive D M, Galvanek E G, Silva F G
Department of Internal Medicine (Nephrology), University of Massachusetts School of Medicine, Worcester.
Am J Nephrol. 1990;10(1):31-6. doi: 10.1159/000168050.
A 57-year-old patient with a history of monoclonal immunoglobulin A (IgA) gammopathy developed idiopathic nephrotic syndrome. Renal biopsy showed minimal glomerular changes with predominant glomerular mesangial IgA. The association of glomerular mesangial IgA with otherwise typical minimal change nephrotic syndrome has been noted before, and the literature concerning this combination of findings is reviewed. The patient herein described represents one of the two oldest patients yet reported with this syndrome and raises questions about the relationship between minimal change disease and IgA nephropathy. Severe proteinuria (and even the nephrotic syndrome) is not necessarily the harbinger of a poor prognosis in IgA nephropathy if the glomerular morphology is otherwise consistent with minimal change nephrotic syndrome. Such patients should be treated in a fashion similar to those with minimal change nephrotic syndrome. The significance of the IgA gammopathy in the pathogenesis of this case is unknown.
一名有单克隆免疫球蛋白A（IgA）丙种球蛋白病病史的57岁患者发生了特发性肾病综合征。肾活检显示肾小球变化轻微，主要为肾小球系膜IgA沉积。肾小球系膜IgA与其他方面典型的微小病变肾病综合征相关联的情况此前已有报道，本文对有关这一组合性发现的文献进行了综述。此处描述的患者是迄今报道的患有该综合征的年龄最大的两名患者之一，这引发了关于微小病变病与IgA肾病之间关系的疑问。如果肾小球形态在其他方面与微小病变肾病综合征一致，那么严重蛋白尿（甚至肾病综合征）不一定是IgA肾病预后不良的预兆。此类患者的治疗方式应与微小病变肾病综合征患者相似。该病例中IgA丙种球蛋白病在发病机制中的意义尚不清楚。
