IgA-dominant postinfectious glomerulonephritis: a report of 13 cases with common ultrastructural features
IgA-dominant postinfectious glomerulonephritis: a report of 13 cases with common ultrastructural features
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DOI：
10.1016/j.humpath.2008.02.015
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发表时间：
2008-09-01
期刊：
影响因子：
3.3
通讯作者：
Bagnasco, Serena M.
中科院分区：
文献类型：
--
作者：
Haas, Mark;Racusen, Lorraine C.;Bagnasco, Serena M.
Nasr等人最近描述了一种以TgA为主的免疫复合物沉积为特征的独特形式的感染后肾小球肾炎（HUM PATHOL 2003；34：1235-1241），每个病例都是在糖尿病患者葡萄球菌感染后发生的。其他人描述了与葡萄球菌感染相关的含有 IgA 的免疫复合物沉积的肾小球肾炎，尽管它们的组织学更加多样化，并且电子显微镜通常没有显示感染后肾小球肾炎典型的大的上皮下沉积物（“驼峰”）。在本报告中，我们描述了 13 例 IgA 为主的感染后肾小球肾炎病例的人口统计学、临床和肾活检结果，每例均以处于不同消退阶段的上皮下驼峰为特征。所有患者均出现肾功能不全（平均血清肌酐+/- SD，4.4 +/- 2.7 mg/dL）、血尿（3 例肉眼可见）和蛋白尿（6 例肾病范围）。根据组织学和电镜检查，感染后肾小球肾炎分为急性 2 例，亚急性 3 例，消退/持续性 8 例。其中 6 例患者近期患有金黄色葡萄球菌感染（Q 甲氧西林耐药），5 例患有糖尿病，3 例患有肾病。共有 4 名患者（3 名活检时血清肌酐 >8.0 mg/dL）发展为终末期肾病，而 9 名患者在活检后 10 +/- 13 个月（范围，2-44）时平均血清肌酐为 2.0 +/- 1.1 mg/dL（范围，0.8-4.4）。总之，IgA 为主的感染后肾小球肾炎在组织学谱和电子显微镜检查结果上与链球菌感染后肾小球肾炎相似，通常与葡萄球菌感染相关，发生于糖尿病患者和非糖尿病患者中，如果就诊时肾功能衰竭不严重，则可能会消退。 (C) 2008 Elsevier Inc. 保留所有权利。
A unique form of postinfectious glomerulonephritis characterized by TgA-dominant immune complex deposits was recently described by Nasr et al (HUM PATHOL 2003;34:1235-1241), each case after a Staphylococcus infection in diabetic patients. Others have described glomerulonephritis with IgA-containing immune complex deposits in association with staphylococcal infections, although their histology was more varied and electron microscopy often did not to show large subepithelial deposits ("humps") typical of postinfectious glomerulonephritis. In this report, we describe demographic, clinical, and renal biopsy findings in 13 cases of IgA-dominant postinfectious glomerulonephritis, each characterized by subepithelial humps at Various stages of resolution. All patients presented with renal insufficiency (mean serum creatinine +/- SD, 4.4 +/- 2.7 mg/dL), hematuria (macroscopic in 3), and proteinuria (nephrotic range in 6). Based on histology and electron microscopy, postinfectious glomerulonephritis was classified as acute in 2 patients, subacute in 3, and resolving/persistent in 8. There were 6 patients who had recent Staphylococcus aureus infections Q methicillin resistant), 5 who were diabetic, and 3 with nephropathy. A total of 4 patients (3 with serum creatinine >8.0 mg/dL at biopsy) developed end-stage renal disease, whereas 9 had a mean serum creatinine of 2.0 +/- 1.1 mg/dL (range, 0.8-4.4) at 10 +/- 13 months (range, 2-44) after biopsy. In summary, IgA-dominant postinfectious glomerulonephritis resembles poststreptococcal glomerulonephritis in its histologic spectrum and electron microscopy findings, is often associated with staphylococcal infections, occurs in diabetics and nondiabetics, and may resolve if renal failure at presentation is not severe. (C) 2008 Elsevier Inc. All rights reserved.