IgA型感染后肾小球肾炎的临床病理与预后研究

目的观察IgA型感染后肾小球肾炎(PIGN)的临床与病理特征,及其与金黄色葡萄球菌感染及潜在糖尿病的相关性。方法回顾性分析IgA型PIGN患者25例,均进行肾组织活检,分析其在光镜病理、免疫荧光显微镜和电子显微镜下变化特点,总结其临床结局。结果所有患者在发病时均为临床金黄色葡萄球菌感染其中MSSA感染11例,MRSA感染14例。肾活检显示:急性期PIGN 6例,表现为弥漫性增生性肾小球肾炎,恢复期或亚急性期显示系膜细胞增生。免疫荧光显示IgA沉积。超微结构分析表明局灶性上皮下驼峰状电子致密物沉积。25例均使用抗生素治疗12例联合应用甲泼尼龙治疗,血液透析依赖8例。其中16例出院,完全缓解6例,部分缓解10例;9例持续住院,死亡5例。结论 IgA型与金黄色葡萄球菌感染有关。诊断主要依靠IgA的免疫荧光染色和存在毛细血管内增殖,电镜检查示上皮下电子致密沉积。

Pathologic and prognostic investigation of IgA dominant post infectious glomerulonephritis

Objective To determine the clinical and pathologic features of IgA dominant post infectious glomerulonephritis（PIGN）,including its association with staphylococcal infections,underlying diabetes,frequency of progression to ESRD,and its pathologic spectrum on renal biopsy.Methods We retrospectively reviewed 25 renal biopsy of PIGN for the past 5 years,and analyzed the pathologic results of light microscopy,immunofluorescence microscopy and electron microscopy.Their clinical outcomes were also summarized.Results All patients at the onset of clinical are S.aureus infections,among them,MSSA infection were 11 cases,MRSA infection in 14 cases.Renal biopsy showed that;acute phase PIGN 6 cases with diffuse proliferative glomerulonephritis,recovery or subacute phase display mesangial cell proliferation.Immunofluorescence showed IgA deposition.Ultrastructural analysis showed that subcutaneous hump-shaped electron dense deposits.25cases were treated with antibiotics theryapy,12 cases were treated with antibiotics combined with methylprednisolone therapy,hemodialysis dependent on eight cases.16 patients discharged from hospital,six cases of complete remission,partial remission in 10 cases;nine cases continued hospitalization,5 patients died.Conclusion IgA dominant post infectious glomerulonephritis are associated with Staphylococcal infections.The diagnosis depends on IgA dominant or co-dominant immunofluorescent staining and the presence of endocapillary proliferation,subepithelial electron dense deposits.