Matsukura Hiro, Sakakibara Masako, Sakamoto Izumi, Tatematsu Miho
Department of Pediatrics, Saiseikai Toyama Hospital, 33-1 Kusunoki, Toyama, 931-8533, Japan.
Department of Nephrology, Nagoya Memorial Hospital, Nagoya, Japan.
CEN Case Rep. 2016 Nov;5(2):131-136. doi: 10.1007/s13730-015-0208-8. Epub 2015 Dec 11.
IgA nephropathy (IgAN), the most prevalent primary chronic glomerulonephritis worldwide, has three major risk factors: hypertension, proteinuria >1 g/day, and severe renal lesions. Obesity also portends a poor prognosis. A Japanese boy with IgAN showed nephrotic syndrome at presentation. Pathological features resembled those of membranoproliferative glomerulonephritis (MPGN), although IgA deposition differed from MPGN and IgAN. Combination therapy improved renal lesions, but rebound deterioration of proteinuria occurred in this patient, who had marked obesity and hypertension. Serial kidney biopsy specimens were compatible with obesity-related glomerulopathy (ORG). Rebound proteinuria was apparently attributable to ORG rather than relapse and flaring up of IgAN.
IgA肾病（IgAN）是全球最常见的原发性慢性肾小球肾炎，有三个主要危险因素：高血压、蛋白尿>1克/天和严重肾损害。肥胖也预示预后不良。一名患有IgAN的日本男孩初诊时表现为肾病综合征。病理特征类似于膜增生性肾小球肾炎（MPGN），尽管IgA沉积与MPGN和IgAN不同。联合治疗改善了肾损害，但该患者出现蛋白尿反弹恶化，其有明显肥胖和高血压。系列肾活检标本符合肥胖相关性肾小球病（ORG）。蛋白尿反弹显然归因于ORG而非IgAN的复发和病情加重。
