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目的:探讨结核病合并IgA肾病的临床和病理特点。方法:回顾性分析山西医科大学第二医院2002年—2006年期间确诊结核病合并经肾活检证实的IgA肾病患者4例,分析其临床和病理特点。结果:男2例,女2例,年龄14~42岁。2例表现为结核性胸膜炎,2例表现为肺结核。结核病发生10d~50d后出现肾损害。4例均表现为慢性肾炎综合征,均有镜下血尿,3例有发作性肉眼血尿;尿蛋白平均0.65g/24h;4例血压及肾功能均正常。肾组织免疫荧光检查发现4例均有明显的系膜区IgA沉积。光镜表现均不严重,轻度系膜增生性肾炎3例,中度系膜增生性肾炎1例;均无新月体形成;肾小管-间质及肾小血管无明显病变。1例患者仅经抗结核治疗后血尿和蛋白尿消失,另3例加用糖皮质激素或(和)免疫抑制剂治疗后尿检完全正常。4例随访期间均无结核病及肾损害复发。结论:结核病可以合并IgA肾病,IgA肾病可能由结核菌感染或抗结核药物引起。
Objective: To investigate the clinical and pathological features of tuberculosis complicated with IgA nephropathy. Methods: Four cases of IgA nephropathy confirmed by renal biopsy in the second hospital of Shanxi Medical University from 2002 to 2006 were retrospectively analyzed. The clinical and pathological features were analyzed. Results: 2 males and 2 females, aged 14 to 42 years old. 2 cases showed tuberculous pleurisy, 2 cases showed tuberculosis. Tuberculosis occurs after 10d ~ 50d kidney damage. 4 cases showed chronic nephritic syndrome, both microscopic hematuria, 3 cases of gross hematuria; urinary protein average 0.65g / 24h; 4 cases of blood pressure and renal function were normal. Renal immunofluorescence revealed four cases of significant mesangial IgA deposition. Light microscopy were not serious, mild mesangial proliferative glomerulonephritis in 3 cases, mesangial proliferative glomerulonephritis in 1 case; no crescent formation; tubulointerstitial and renal vascular no obvious lesion. One patient died of hematuria and albuminuria only after anti-TB treatment, and the other three were completely normal after treatment with glucocorticoids or (and) immunosuppressive agents. No recurrence of tuberculosis and renal damage occurred in 4 cases during follow-up. Conclusion: Tuberculosis can be associated with IgA nephropathy, which may be caused by infection with tuberculosis or anti-TB drugs.