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目的探讨原发性膜性肾病合并IgA肾病的临床、病理特点及诊断要点。方法分析我院确诊的2例膜性肾病合并IgA肾病病例的临床和病理资料,并进行文献复习。结果两例均为男性,年龄分别为17岁、73岁。例1表现为肾病综合征伴镜下血尿;例2以蛋白尿伴镜下血尿发病,9年后出现肾病综合征。两例血压及肾功能均正常。肾脏病理:光镜下均见肾小球基底膜空泡变性和增厚,系膜细胞和基质增生;免疫荧光见IgG和C3颗粒样沿肾小球毛细血管壁沉积,IgA团块状在系膜区沉积;电镜下均见肾小球上皮细胞下多数团块状电子致密物沉积,系膜区见团块状电子致密物沉积,上皮细胞足突广泛融合。两例均予激素治疗缓解,随访29~41个月肾功能正常。结论原发性膜性肾病合并IgA肾病临床表现无特异性,病理上兼具有膜性肾病和IgA肾病的病理特点。免疫荧光和电镜、免疫电镜在诊断中具有重要意义。
Objective To investigate the clinical features, pathological features and diagnosis points of primary membranous nephropathy complicated with IgA nephropathy. Methods The clinical and pathological data of 2 cases of membranous nephropathy with IgA nephropathy diagnosed in our hospital were analyzed and reviewed. Results Both cases were male, with the age of 17 years and 73 years respectively. Case 1 showed nephrotic syndrome with microscopic hematuria; Case 2 with proteinuria with microscopic hematuria, nephrotic syndrome after 9 years. Two cases of blood pressure and renal function were normal. Renal pathology: The glomerular basement membrane vacuolar degeneration and thickening, mesangial cells and stromal hyperplasia were observed under light microscope. Immunofluorescence showed that IgG and C3 particles were deposited along the glomerular capillary wall, Membrane deposition; under electron microscopy, most of the massive glomerulus epithelial cells dense lumps of electron-dense deposition, the mesangial area to see the massive electron dense deposition, epithelial cell foot process a wide range of fusion. Both cases were relieved hormone therapy, follow-up of 29 to 41 months of normal renal function. Conclusion Primary membranous nephropathy with non-specific clinical manifestations of IgA nephropathy, both pathological features of membranous nephropathy and IgA nephropathy. Immunofluorescence and electron microscopy, immunoelectron microscopy in the diagnosis of great significance.