IgA肾病合并原发性膜性肾病二例并文献复习

Two cases report and literature review of IgA nephropathy combined with primary membranous nephropathy

目的探讨IgA肾病合并原发性膜性肾病的临床表现及病理特点.方法分析2例经临床、常规病理检查以及进一步的免疫电镜证实的IgA肾病合并原发性膜性肾病患者的临床表现及病理特点.结果2例患者临床上均可除外继发性肾脏病;免疫电镜证实,IgA沉积于系膜区电子致密物内,IgG沉积于上皮下电子致密物内;2例患者均表现为中～大量的蛋白尿,血尿轻微,肾功能正常.经9个月的随访,肾功能稳定.结论IgA肾病合并原发性膜性肾病较为罕见,临床表现更似于膜性肾病,这两种肾小球疾病合并存在可能对患者的预后并无负面影响.

Objective To describe the clinical and pathological characteristics and prognosis of IgA nephropathy coexisting with membranous nephropathy （MN）. Methods Two cases were confirmed to have IgA nephropathy as well as primary MN by immuofluorescence and immuno-electron microscopy for renal biopsy and clinical data. Clinical and pathological manifestations were collected and prognosis was investigated. Results The pathological characteristics included IgA deposit in mesangium but IgG deposit in subepithelial site mainly. Two patients presented moderate to heavy proteinuria, minimal hematuria, and normal renal function. During 9 months of follow up, the renal function remained normal. Condusious The combined form of membranous nephropathy and mesangioproliferative IgA nephropathy was uncommon, The clinical characteristics of the two cases in this study were more similar to those of MN. Coexistence of two kinds of primary glomerulonephritis did not result in a particularly deterioration in clinical outcome.