儿童IgA肾病合并急性链球菌感染后肾小球肾炎2例报告并文献复习

Children's IgA nephropathy combined with acute post-streptococcal glomerulonephritis: a report of 2 cases and literature review

目的探讨IgA肾病和急性链球菌感染后肾小球肾炎的诊断和鉴别诊断思路。方法回顾性分析2015年和2017年各1例于首都儿科研究所附属儿童医院肾脏内科住院治疗的IgA肾病合并急性链球菌感染后肾小球肾炎患儿的病例资料,并复习相关文献。结果 2例患儿均为女性,年龄均为7岁,临床表现为大量蛋白尿、反复肉眼血尿、肾功能不全、补体C3降低和抗链球菌溶血素O升高。肾脏病理免疫荧光结合光镜检查符合中度系膜增生性IgA肾病;电镜可见上皮下驼峰状电子致密物沉积。结论 IgA肾病和急性链球菌感染后肾小球肾炎二者合并发生较为罕见,对于诊断为急性链球菌感染后肾小球肾炎但肉眼血尿反复的患儿,应注意二者同时发生的可能。

Objective To explore the diagnosis and differential diagnosis of IgA nephropathy and acute post-streptococcalglomerulonephritis(APSGN). Method The clinical data of 2 children with IgA nephropathy combined with APSGN were retrospectivelyanalyzed. The pertinent literature were reviewed. Result In 2 females both aged 7 years, the clinical features were a large amount ofproteinuria, recurrent gross hematuria, renal insufficiency, low serum C3 levels and positive antistreptolysin-O (ASO) titres. Renalpathology immunofluorescence and light microscopy findings were in accord with moderate mesangial proliferative IgA nephropathy.Electron microscope showed the deposition of hump-like electron dense deposits under the epithelium. Conclusion It is rare that IgAnephropathy combined with APSGN at the same time. Attention should by paid to those who had been diagnosed with APSGN but withrecurrent gross hematuria because it is possible that APSGN and IgA nephropathy may occurred at the same time.