Kobayashi Mayumi, Usui Joichi, Sakai Kentaro, Mase Kaori, Iwabuchi Satoshi, Nagata Michio, Kobayashi Masaki, Yamagata Kunihiro
Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan.
Intern Med. 2015;54(9):1081-4. doi: 10.2169/internalmedicine.54.3655. Epub 2015 May 1.
A 71-year-old woman was admitted with nephrotic syndrome. Light and electron microscopic analyses of renal biopsy tissue showed typical diffuse membranous features. In contrast, granular deposition of immunoglobulin A (IgA), but not IgG, IgM, C3 or C1q, was observed along the capillary walls on immunofluorescence. The patient was pathologically diagnosed with diffuse membranous nephropathy with solitary IgA deposition. Secondary membranous nephropathy was suspected; however, no underlying cause was found. The clinical and pathological findings, except for those of immunofluorescence, were all compatible with a diagnosis of primary membranous nephropathy. This is the first reported case of membranous nephropathy associated with solitary IgA deposition.
一名71岁女性因肾病综合征入院。对肾活检组织进行光镜和电镜分析显示出典型的弥漫性膜性特征。相比之下,免疫荧光检查发现沿毛细血管壁有免疫球蛋白A(IgA)颗粒状沉积,而IgG、IgM、C3或C1q未见沉积。该患者经病理诊断为伴有孤立性IgA沉积的弥漫性膜性肾病。怀疑为继发性膜性肾病;然而,未发现潜在病因。除免疫荧光检查结果外,临床和病理表现均符合原发性膜性肾病的诊断。这是首例报道的伴有孤立性IgA沉积的膜性肾病病例。