以急性肾小球肾炎起病的IgA肾病10例

Ten Cases of Immunoglobulin A Nephropathy with an Onset of Acute Glomerulonephritis

目的研究以急性肾小球肾炎(AGN)起病的IgA肾病(IgAN)的临床特点。方法本科收治1994年1月～2005年12月以AGN起病的IgAN患儿108例。男77例,女31例;起病年龄3.2～14.0岁。回顾分析其临床和病理特点。结果IgAN108例中,以AGN起病的患儿10例(9.3%)。10例均有水肿、血尿和蛋白尿。其中8例为肉眼血尿,持续2d～2个月;4例有反复肉眼血尿;镜下血尿持续16个月。尿蛋白定性+～+++,持续1～8个月。起病时高血压及血BUN和Scr增高各2例。9例检测ASO,5例增高。2例抗链球菌DNA酶B抗体升高。血清C3降低4例。8例有前驱病,感染至起病间隔1～5d。肾活检光镜检查9例为系膜增生,1例为局灶节段性肾小球硬化。免疫荧光检查均以IgA沉积为主。结论以AGN起病的IgAN前驱感染与肾炎症状起病间隔时间较短,肉眼及镜下血尿持续时间较长或反复加重。此类患儿应予作活检以明确是否为IgAN。

Objective To analyze the clinical features of iromunoglobulin A（IgA） nephropathy（IgAN） occurring in the context of previous acute gJomcruloncphritis. Methods The clinicopathologic features of 108 cases（77 males,31 females, aged 3.2 to 14.0 years old） of IgAN were analyzed restrospectively with the onset of acute glomerulonephritis in this department from Jan. 1994 to Dec. 2005. Results Of 108 cases with IgAN, 10 Cases were with the onset of acute glomcruloncphrifis. All the l0 cases presented with edema, hcmaturia and protcinuria. Eight cases had macroscopic hematuria, lasting for 2 days to 2 months. Four cases had recurrent macroscopic hematuria, microscopic hematuria lasting for 16 months. Urine protein qualitative ＋ - ＋ ＋ ＋ lasted for 1 -8 months. Two eases had hypcrlension;2 cases had increasing blood uria nitrogen and serum creatininc. The increase of anti - strcptolysin O（ASO） titcr was detected in 5 of 9 cases. Two cases had a high titcr of DNasc - B antibody, and 4 cases had hypocomplcmcntcroia. Eight cases had prodromal infection with an interval time varying from 1 to 5 days. Renal biopsies revealed mcsangial proliferative glomcruloncphritis in 9 cases and focal segmental glomcrulosclcrosis in 1 case, all with mcsangial lgA deposition. Conclusions The interval time between the prodroroal infection and nephritis symptoms is mostly short in IgAN with the onset of acute glomerulonephritis, while macroscopic and microscopic heroaturia remain a fairly long time or recurrently aggravate. Renal biopsy is necessary to diagnose IgAN for this kind of children.