移植肾IgA肾病合并慢性钙调蛋白抑制剂肾毒性

IgA nephropathy with chronic calcineurin inhibitor nephrotoxicity after kidney transplantation

青年男性患者,肾移植术后7年,应用吗替麦考酚酯、他克莫司、泼尼松等免疫抑制治疗,临床表现为大量蛋白尿伴少量镜下血尿,肾活检组织学为局灶节段性肾小球硬化,免疫荧光肾小球Ig A沉积,同时小动脉壁中膜和外膜见滴状透明变性。结合临床,考虑移植肾Ig A肾病合并钙调磷酸酶抑制剂肾毒性。

A 34-year-old male presented with massive proteinuria and mild microscopic hematuria seven years after kidney transplantation,treated with immunosuppressive therapy of mycophenolate mofetil,tacrolimus and prednisone.Renal biopsy revealed focal segmental glomerulosclerosis with Ig A deposition,and nodular hyaline deposits in the media and adventitia of arterioles.The final diagnosis was allograft Ig A nephropathy with calcineurin inhibitor nephrotoxicity.