ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2014, Vol. 23 ›› Issue (6): 577-581.

• 论文 • 上一篇    下一篇

C3肾小球肾炎转为单克隆IgG沉积的增生性肾小球肾炎

  

  • 出版日期:2014-12-28 发布日期:2014-12-31

C3 glomerulonephritis change to monoclonal IgG deposits glomerulonephritis observed by repeat renal biopsy

  • Online:2014-12-28 Published:2014-12-31

摘要:

摘要 中年女性,首诊临床表现少量蛋白尿及镜下血尿,肾功能正常,轻度贫血,血压正常,补体及血轻链正常;肾活检显示肾小球重度系膜增生性病变伴C3沉积为主。近5个月病情加重,出现中-大量尿蛋白伴镜下血尿,血肌酐逐步升高,血压升高,补体轻度下降,贫血加重,血轻链κ/λ比例增高,血清免疫固定电泳未见单克隆免疫球蛋白条带,骨髓活检和骨髓细胞学检查均阴性,重复肾活检组织学改变为肾小球膜增生样病变,免疫荧光单克隆IgG3-κ沉积,电镜下肾小球系膜区及基膜内皮下电子致密物沉积为主,上皮侧偶见电子致密物沉积,沉积物无特殊结构,诊断为单克隆IgG沉积的增生性肾小球肾炎(IgG3-κ型)。

关键词: C3肾小球肾炎, 单克隆IgG沉积的增生性肾小球肾炎, 肾活检

Abstract:

ABSTRACT A 58-year-old female, was first admitted because of mild proteinuria and microscopic hematuria, normal renal function, with anemia. She was normotensive with normal C3 level and κ:λ ratio. Renal biopsy showed mesangioproliferative glomerulonephritis with isolated C3 deposits. The last five months, she had increased proteinuria and hematuria, renal dysfunction, hypertension, decreased serum C3, anemia, elevated κ:λ ratio, with negative immunofixation electrophoresis, and normal finding in bone marrow biopsy and bone marrow cytomorphologic examinations. A repeat renal biopsy revealed a membranoproliferative glomerulonephritis, immunofluorescence demonstrated glomerular deposits that stained for IgG3 and kappa light chain, and electron microscopy revealed global mesangial and subendothelial electron-dense deposits, rare segmental subepithelial deposits of nonorganized feature. The diagnosis was proliferative glomerulonephritis with monoclonal IgG deposits (IgG3-κ).

Key words: C3 glomerulonephritis, proliferative glomerulonephritis with monoclonal IgG deposits, renal biopsy