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丙型肝炎诱发的免疫球蛋白A(IgA)肾病:血尿的罕见病因。

Hepatitis C-Induced Immunoglobulin A (IgA) Nephropathy: An Uncommon Cause of Hematuria.

作者信息

Kakumani Jagadeswar, Narne Krishna Geetha, Koduri Amukthamalyada, Lankapothu Prem Balaji Reddy, Kumar S Magesh

机构信息

Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.

General Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.

出版信息

Cureus. 2024 Sep 25;16(9):e70168. doi: 10.7759/cureus.70168. eCollection 2024 Sep.

Abstract

Immunoglobulin (Ig)A nephropathy, also known as Berger's disease, is characterized by IgA deposits in the kidney's mesangium and can lead to serious outcomes, including rapidly progressive glomerulonephritis. While Hepatitis C virus (HCV) infection is commonly associated with liver involvement, it is also linked to various renal pathologies, including membranous nephropathy and membranoproliferative glomerulonephritis. However, IgA nephropathy secondary to HCV is rare. This case study involves a 24-year-old male with a known history of untreated Hepatitis C, who presented with hematuria and foamy urine. Laboratory findings revealed increased levels of serum creatinine and urea, significant proteinuria, and a high HCV RNA viral load. A renal biopsy confirmed the diagnosis of IgA nephropathy with strong IgA and C3 deposits observed on immunofluorescence. Treatment with angiotensin receptor blockers and antiviral therapy led to substantial symptomatic improvement and stabilization of renal function. This case underscores the critical importance of considering IgA nephropathy in the differential diagnosis of renal complications in HCV-infected patients. Early detection and treatment of Hepatitis C are vital, as timely intervention can markedly enhance patient outcomes and mitigate the risk of serious complications. A heightened awareness of the potential renal implications of HCV emphasizes the urgency of proactive monitoring and swift management to safeguard kidney function and overall health.

摘要

免疫球蛋白A(Ig)肾病,又称伯杰氏病,其特征是IgA沉积于肾脏系膜,可导致严重后果,包括快速进展性肾小球肾炎。虽然丙型肝炎病毒(HCV)感染通常与肝脏受累有关,但它也与各种肾脏病变有关,包括膜性肾病和膜增生性肾小球肾炎。然而,继发于HCV的IgA肾病很少见。本病例研究涉及一名24岁男性,有未经治疗的丙型肝炎病史,出现血尿和泡沫尿。实验室检查结果显示血清肌酐和尿素水平升高、大量蛋白尿以及高HCV RNA病毒载量。肾活检确诊为IgA肾病,免疫荧光检查可见强IgA和C3沉积。使用血管紧张素受体阻滞剂和抗病毒治疗后,症状得到显著改善,肾功能稳定。本病例强调了在HCV感染患者肾脏并发症的鉴别诊断中考虑IgA肾病的至关重要性。丙型肝炎的早期检测和治疗至关重要,因为及时干预可显著改善患者预后并降低严重并发症的风险。提高对HCV潜在肾脏影响的认识,凸显了积极监测和迅速管理以保护肾功能和整体健康的紧迫性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f67b/11505565/dd4f5ef08214/cureus-0016-00000070168-i01.jpg

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