Idiopathic IgA nephropathy.

摘要: A 54-year-old white man was admitted to the New England Medical Center (NEMC) for a percutaneous renal biopsy. Four years earlier mild hypertension and 3+ proteinuria had been discovered during routine physical examination. At that time serum creatinine 1.2 mg/dI BUN 15 mg/dl. Intravenous pyelography revealed normally functioning kidneys; right measured 12.5 cm left 13.5 cm. Treatment with hydrochlorothiazide reserpine begun. Two one-half before admission, 1.8 mg/dl 24 One urinalysis 4+ protein 25 red blood cells per high-power field; 2.1 29 Three months prior admission 2.6 28 mg/dl; 24-hour urine excretion 12 g. Physical examination pressure of 200/100 mm Hg. Funduscopic showed only arteriovenous nicking. The lungs were clear percussion auscultation. Cardiac normal SI S2 sounds without rubs, murmurs, or gallops. There 1 + pretibial edema. remainder unrevealing. Laboratory studies following pertinent data. Urinalysis disclosed specific gravity 1.017, pH 6, 2+ protein, blood. Microscopic sediment 50 80 I 3 field, hyaline casts, one pigmented cast. culture sterile. 3.8 38 5.7g. Light microscopic study biopsy material benign nephrosclerosis acute interstitial nephritis eosinophils predominating in cell infiltrate. Immunofluorescence microscopy mesangial deposits IgA, trace IgG, C3, 1+ C4, no 1gM; these findings thought be diagnostic IgA nephropathy. short course prednisone, given treat possible diuretic-induced allergic nephritis, demonstrable effect, patient's function continued deteriorate. Sixteen after performed, 10.2 ill Hemodialysis instituted plans made transplantation.