IgA为主型感染相关性肾小球肾炎伴草酸盐沉积1例及文献复习
收稿日期: 2024-06-16
网络出版日期: 2025-03-05
基金资助
甘肃省人民医院院内科研基金——膜性肾病患者B细胞激活因子(BAFF);预后评估的相关临床研究(22JR11RA265);甘肃省自然科学基金——KM55单克隆抗体在原发性IgA肾病患者中的临床意义(21JR7RA625);预后评估及复发的相关性研究(22GSSYB-12)
IgA-dominant infection-related glomerulonephritis with oxalate deposition: A case report and literature review
Received date: 2024-06-16
Online published: 2025-03-05
目的 本文报道1例民间土法治疗关节炎致皮肤烫伤溃烂结痂愈合,后继发IgA为主型感染相关性肾小球肾炎(IgA-IRGN)伴草酸盐沉积患者,观察其临床病理特点,探讨心、肾、关节病变之间的相关关系。方法 患者入院后完善心脏超声、膝关节MRI,行肾穿刺活检及关节腔内穿刺液培养,观察其临床病理特点及治疗后转归。结果 经过抗感染、降尿蛋白、改善心功能等治疗后病情好转。结论 IgA-IRGN多见于2型糖尿病和免疫力低下的老年人群,该病例无上述基础疾病,肾病综合征表现合并急性肾损伤、骨性关节炎、重度二尖瓣关闭不全及二尖瓣脱垂,多病共存使得病情更为复杂。对于IgA-IRGN感染源隐匿时临床易误诊、漏诊,在诊治时需提高警惕。
关键词： 肾小球肾炎, IGA; 金黄色葡萄球菌; 骨关节炎
赵慧 , 张鹏伟 , 张健 , 黄文辉 , 李小丽 , 马志刚 , 金芳 , 田利民 . IgA为主型感染相关性肾小球肾炎伴草酸盐沉积1例及文献复习[J]. 临床荟萃, 2025 , 40(2) : 162 -167 . DOI: 10.3969/j.issn.1004-583X.2025.02.012
Objective This article reports a patient who developed immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IgA-IRGN) with oxalate deposition following skin burns, ulceration, scab formation, and healing caused by folk remedies for arthritis. To observe the clinicopathological features and explore the correlation between the heart, kidney and joint lesions. Methods After admission, the patient underwent echocardiography, knee joint magnetic resonance imaging (MRI), renal biopsy, and culture of synovial fluid from the joint cavity. The clinical and pathological characteristics were observed, and the outcomes after treatment were analyzed. Results The patient's condition improved after treatment with anti-infective therapy, proteinuria reduction, and cardiac function improvement. Conclusion IgA-IRGN is commonly seen in elderly individuals with type 2 diabetes and immunodeficiency. However, this case did not involve these underlying conditions. The patient presented with nephrotic syndrome, acute kidney injury, osteoarthritis, severe mitral regurgitation, and mitral valve prolapse. The condition is further complicated by the coexistence of multiple diseases. When the infection source of IgA-IRGN is occult, clinical misdiagnosis and missed diagnosis are common. Therefore, increased vigilance is needed during diagnosis and treatment.
Key words： glomerulonephritis, IGA; Staphylococcus aureus; osteoarthritis
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