1例单克隆IgG沉积的增生性肾小球肾炎临床分析  

Proliferative glomerulonephritis with monoclonal IgG deposits——a case report and review

作　　者：方奕[1] 吴限[1] 杨俊伟[1] 

机构地区：[1]南京医科大学第二附属医院肾脏病中心,江苏省南京市210003

出　　处：《实用老年医学》2014年第10期832-835,838,共5页Practical Geriatrics

摘　　要：目的探讨单克隆IgG沉积的增生性肾小球肾炎(proliferative glomerulonephritis with monoclonal IgG deposits,PGNMID)的临床病理特点,加深对PGNMID的认识。方法分析1例PGNMID患者的临床病理特点,并对PGNMID相关文献进行复习。结果 PGNMID是一种少见疾病,以中、老年患者常见,主要临床表现包括蛋白尿、血尿,多数伴肾功能不全。肾活检病理组织学表现为肾小球增生性病变或膜增生样病变,免疫荧光检查肾小球内单克隆IgG沉积,电镜观察见沿肾小球毛细血管袢和(或)肾小管基膜外侧细沙样电子致密物沉积。结论老年肾病综合征或大量蛋白尿患者,尤其肾活检证实肾小球内单一免疫球蛋白IgG沉积者,应行IgG亚型染色及肾组织轻链染色,当电镜发现沿肾小球毛细血管袢特殊的电子致密物沉积时,应结合临床及实验室检查结果,诊断PGNMID,并寻找可能的病因,以提高PGNMID的诊断水平。Objective To explore the clinical and pathological features of proliferative glomerulonephritis with monoclonal IgG deposits（ PGNMID）. Methods Clinical and pathological features of a PGNMID case were analyzed and the related literatures were reviewed. Results PGNMID is a rare disease characterized by monoclonal IgG in glomerular depo-sits which are grannular dense on electron microscopy. The main light microscopic pattern is proliferative glomerulonephritis. The disease presents clinically with proteinuria,hematuria and frequent renal insufficiency. Conclusions We recommend that the patients with glomerular immune positive staining for IgG and a single light chain should receive the detection of immunostaining for the IgG subclasses and electron microscopy to confirm the diagnosis of PGNMID.

关 键 词：单克隆IgG 增生性肾小球肾炎 临床病理特点 

分 类 号：R692.3[医药卫生—泌尿科学]