Ramirez S B, Rosen S, Niles J, Somers M J
Division of Nephrology, Children's Hospital, Boston, MA 02115, USA.
Am J Kidney Dis. 1998 Feb;31(2):341-4. doi: 10.1053/ajkd.1998.v31.pm9469508.
Anti-neutrophil cytoplasmic antibodies (ANCAs) of the immunoglobulin (Ig) G isotype are associated with rapidly progressive glomerulonephritis. These have been detected rarely in patients with Henoch-Schönlein purpura (HSP) and have only been previously reported once in a patient with IgA nephropathy (IgAN). In contrast, IgA-ANCAs have been detected in patients with HSP or IgAN, although further verification of this finding by various investigators has yielded conflicting results. We report a case of biopsy-proven IgAN in which the patient developed a rapidly progressive glomerulonephritis and was determined to have ANCAs of both IgA and IgG isotypes. This report suggests an association between fulminant IgAN and ANCA-associated disease and that ANCAs may be underdetected in children with previously diagnosed IgAN. Identification of these antibodies may guide further management of these patients.
免疫球蛋白（Ig）G 同种型的抗中性粒细胞胞浆抗体（ANCA）与快速进展性肾小球肾炎相关。这些抗体在过敏性紫癜（HSP）患者中很少被检测到，并且此前仅在 1 例 IgA 肾病（IgAN）患者中报道过 1 次。相比之下，在 HSP 或 IgAN 患者中已检测到 IgA-ANCA，尽管不同研究者对这一发现的进一步验证得出了相互矛盾的结果。我们报告 1 例经活检证实的 IgAN 病例，该患者发展为快速进展性肾小球肾炎，并且被确定同时具有 IgA 和 IgG 同种型的 ANCA。本报告提示暴发性 IgAN 与 ANCA 相关疾病之间存在关联，并且在先前诊断为 IgAN 的儿童中，ANCA 可能未被充分检测到。识别这些抗体可能有助于指导对这些患者的进一步管理。
