原发性膜性肾病合并IgA肾病3例临床病理分析

Primary membranous nephropathy combined with IgA nephropathy:a clinicopathological analysis of three cases

目的探讨原发性膜性肾病合并IgA肾病的临床病理特征。方法分析3例经肾活检病理检查及实验室检查证实的原发性膜性肾病合并IgA肾病患者的临床表现及病理特点。结果2例患者呈肾病综合征表现,伴或不伴轻微镜下血尿,肾小球基底膜增厚,系膜无明显增生/轻度增生;1例呈慢性肾炎综合征表现,有发作性肉眼血尿并伴有高血压,肾小球基底膜弥漫增厚,伴轻至中度系膜增生、内皮细胞节段增生、小细胞性新月体形成及纤维素样坏死。结论原发性膜性肾病合并IgA肾病较为罕见,部分患者临床表现与膜性肾病相近,也有患者病理及临床表现以IgA肾病为主。

Objective To describe the clinicopathologic features of primary membranous nephropathy(PMN)combined with IgA nephropathy(IgAN).Methods Three cases were confirmed to have PMN combined with IgAN by renal pathology and laboratory data.Results Two patients presented nephritic syndrome with or without mild microscopic hematuria,while glomerular basement membrane thickening with or without mild mesangial hypercellularity was observed.One patient presented chronic glomerulonephritis with macrohematuria and hypertension,while glomerular basement membrane thickening with mild to moderate mesangial hypercellularity,segmental endocapilary hypercellularity,small glomerular crescents and fibriniod necrosis.Conclusion PMN combined with IgAN is rare.The clinicopathologic features of some of them are more similar to those of MN,while othes more similar to those of IgAN.