银屑病合并IgA或非IgA系膜增生性肾小球肾炎六例临床病理分析

目的分析银屑病合并肾损害的临床病理特点。方法回顾性分析北京协和医院1983年至2004年有肾活检结果的银屑病并肾损害患者6例，分析其临床及病理特点。结果男性2例，女性4例，平均年龄38岁。肾损害在银屑病发病后平均16年(7—30年)被发现。2例表现为无症状性镜下血尿和蛋白尿；3例表现为慢性肾炎综合征；1例为肾病综合征。6例均有中大量镜下血尿，其中2例有发作性肉眼血尿：蛋白尿平均为2．05g／24h(0．01—5．42g／24h)；血压4例正常，2例升高；Scr均正常。肾组织免疫荧光检查发现系膜区IgA沉积4例，系膜区IgG沉积1例，免疫荧光阴性1例。光镜表现均不严重，轻度系膜增生3例，中度系膜增生3例；均无新月体形成；慢性肾小管间质病变不明显；2例肾内动脉内膜增生、管腔狭窄。结论在银屑病合并肾损害中，系膜增生性。肾小球肾炎并不少见。可能与银屑病存在一定关系。

Clinicopathological analysis of 6 cases with IgA or non-IgA mesangial proliferative glomerulonephritis associated with psoriasis

Objective To analyze the clinical and pathologic characteristics of IgA or non-IgA mesangial proliferative glomerulonephritis associated with psoriasis. Methods Clinical and pathologic data from 6 patients suffered from IgA or non-IgA mesangial proliferative glomerulonephritis associated with psoriasis were reviewed. They were admitted to our hospital from 1983 to 2004 and diagnosed by renal biopsy. Results Two male and four female patients were average thirty-eight years old. Renal damages occurred at average sixteen years after diagnosis of psoriasis.Two patients presented asymptomatic hematuria or proteinuria, three with chronic glomerulonephritis and one with nephritic syndrome. All patients suffered from microhemaluria and two from macrohematuria. The average 24 hours proteinuria was 2.05 g. Two had hypertension. All serum creatinine results were normal. Immunofluorescent examination of renal biopsy showed four cases with IgA deposited in mesangium, one with IgG deposited in mesangium, and one with negative immunofluorescent result. Microscopy examination showed three with mild and the others with moderate mesangial proliferation. No crescents and severe chronic tubulointerstilial lesions were found. Two cases showed intimal hyperplasia and stenosis of small renal arteries. Conclusions It is quite common that IgA or non-IgA mesangial proliferative glomerulonephritis in renal involvement is associated with psoriasis. Mesangial proliferative glomerulonephrilis may be related to psoriasis.