肥胖相关性肾病伴IgA肾病2例临床病理分析

Obesity-Related Nephropathy Associated with IgA Nephropathy:a Clinicopathological Analysis of Two Cases

目的:探讨肥胖相关性肾病(ORG)伴IgA肾病的组织形态学特征、诊断、鉴别诊断、治疗及预后。方法:回顾性分析2例ORG伴IgA肾病的临床病理资料,并结合文献进行复习。结果:2例均为成年人,男女各1例,中位年龄35.5岁;以尿检异常为主要症状,体型肥胖,BMI均超正常值。光镜示:肾小球显著肥大,系膜区及系膜旁区沉积物伴一定数量的肾小球硬化。免疫组化显示以IgA沉积为主的系膜区沉积。电镜显示系膜区少量沉积物伴足突融合及微绒毛变性。结论:ORG伴IgA肾病非常罕见,依赖病理形态学和免疫表型,结合患者有肥胖及BMI超标即可确诊。病理学上需与IgA沉积及肾小球硬化相关肾病加以鉴别。ORG伴IgA肾病治疗方法多种,其预后较难预测。

Objective：To study the histomorphological characteristics,diagnosis and differential diagnosis of obesity-related glomerulopathy（ORG） associated with IgA nephropathy.Methods：Two cases of ORG associated with IgA nephropathy were reported and the literatures were reviewed.Results：The two cases occurred in 1 woman and 1 man,median age 35.5 years,the main symptoms of urinary abnormalities,overweight,BMI surpassed the normal value.Microscopic showed that ORG associated with IgA nephropathy included：diffuse glomeruli hypertrophy,mesangial and paramesangial deposition and a certain number of glomerular sclerosis.Immunohistochemistry showed that the IgA deposits in the mesangial area deposition.Ultrastructurally showed that mesangial deposits with a small amount of fusion of foot processes and microvilli degeneration.Conclusion：ORG associated with IgA Nephropathy is extremely rare.Its diagnosis is mainly relying on its clinical manifestation,pathology,phenotype,patients with obesity and overweight BMI.Differential diagnosis between IgA deposition associated nephropathy and glomerular sclerosis associated nephropathy is necessary.Treatments are diverse,while the prognosis is difficult to predict.