Division of Nephrology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY, USA.
Am J Kidney Dis. 2012 Dec;60(6):1039-43. doi: 10.1053/j.ajkd.2012.04.032. Epub 2012 Jul 6.
We report the case of a 63-year-old man who presented with acute kidney injury, active urine sediment, nephrotic syndrome, and hypocomplementemia after a recent report of a sore throat. Kidney biopsy showed diffuse proliferative and exudative glomerulonephritis with C3-dominant staining by immunofluorescence. Taken together, clinical and pathologic findings were most suggestive of acute postinfectious glomerulonephritis, although the history of full nephrotic syndrome, presence of segmental membranoproliferative features, and absence of classic subepithelial hump-shaped deposits were unusual for this condition. Three months after the initial biopsy, the patient continued to have hypocomplementemia and nephrotic syndrome, prompting a repeated kidney biopsy that showed findings most consistent with C3 glomerulopathy. C3 glomerulopathy is a proliferative pattern of glomerulonephritis characterized by complement deposits that stain solely or dominantly for C3. A subset of cases of C3 glomerulopathy have features that overlap extensively with acute postinfectious glomerulonephritis. Clinicians and pathologists should be aware of the similar findings seen in these 2 conditions.
我们报告了一例 63 岁男性病例，他在近期出现咽痛后出现急性肾损伤、活动性尿沉渣、肾病综合征和低补体血症。肾活检显示弥漫性增生和渗出性肾小球肾炎，免疫荧光染色以 C3 为主。综合临床和病理表现，最符合急性感染后肾小球肾炎，但该病例的完整肾病综合征病史、存在节段性膜增殖性特征以及无典型上皮下驼峰状沉积物均不常见。初次肾活检后 3 个月，患者持续存在低补体血症和肾病综合征，因此再次进行肾活检，结果最符合 C3 肾小球病。C3 肾小球病是一种以补体沉积为特征的增生性肾小球肾炎，仅或主要染色为 C3。C3 肾小球病的一部分病例具有与急性感染后肾小球肾炎广泛重叠的特征。临床医生和病理学家应注意这两种疾病中所见的相似表现。
