Umezawa Yukako, Aoki Ryosuke, Ichikawa Daisuke, Suzuki Yusuke, Suzuki Tomo
Department of Nephrology, Kameda Medical Center, 929, Higashicho, Kamogawa, Chiba, 296-8602, Japan.
Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
J Nephrol. 2025 Feb 13. doi: 10.1007/s40620-025-02213-9.
Immunoglobulin A nephropathy (IgAN) is associated with liver diseases, including alcoholic cirrhosis. When IgAN occurs in patients with liver disease, it is referred to as secondary IgAN; however, the mechanisms underlying secondary IgAN remain unclear. Herein, we present a case report of IgAN in a patient with a history of alcoholic liver cirrhosis, who presented with hematuria and proteinuria. A kidney biopsy revealed diffuse subendothelial deposition and mild mesangial proliferation. Immunofluorescence showed strong positive signals for IgA and IgM in the glomerular capillaries. There were no restrictions between the kappa and lambda staining. Electron microscopy revealed electron-dense deposits in the mesangial and subendothelial kidney regions. Histological diagnosis confirmed IgAN, typically associated with alcoholism. Further examination revealed that galactose-deficient IgA1 antibodies had merged with IgA, and a positive staining for the apoptosis inhibitor of macrophage antibodies along the glomerular capillaries was observed. These findings suggest that primary IgAN and alcoholic cirrhosis-related IgAN may share a common underlying mechanism.
免疫球蛋白A肾病（IgAN）与包括酒精性肝硬化在内的肝脏疾病有关。当IgAN发生在肝病患者中时，被称为继发性IgAN；然而，继发性IgAN的潜在机制仍不清楚。在此，我们报告一例有酒精性肝硬化病史的IgAN患者，该患者表现为血尿和蛋白尿。肾活检显示弥漫性内皮下沉积和轻度系膜增生。免疫荧光显示肾小球毛细血管中IgA和IgM呈强阳性信号。κ和λ染色之间没有限制。电子显微镜显示系膜和肾内皮下区域有电子致密沉积物。组织学诊断证实为IgAN，通常与酗酒有关。进一步检查发现，缺乏半乳糖的IgA1抗体与IgA合并，并观察到沿肾小球毛细血管的巨噬细胞凋亡抑制抗体呈阳性染色。这些发现表明，原发性IgAN和酒精性肝硬化相关的IgAN可能有共同的潜在机制。
