IgG4相关肾小管间质性肾炎合并IgA肾病一例并文献复习

李艳华 冯敏 罗福漳

【摘要】目的提高临床医师对IgG4相关肾小管间质性肾炎合并IgA肾病的认识水平。方法 收集一例IgG4相关肾小管间质性肾炎合并IgA肾病患者的病例资料，并以“IgG4”“间质性肾炎”“IgA肾病”为检索词，在PubMed、万方数据知识服务平台、中国学术文献网络出版总库、维普中文科技期刊数据库中检索，综合国内外报道的相关资料对该病进行文献复习。结果患者男，62岁，夜尿增多4年，排泡沫尿5个月，外周血IgG水平升高、IgG4水平升高、血清肌酐升高，经肾脏病理活组织检查确诊IgG4相关肾小管间质性肾炎合并IgA肾病，予糖皮质激素联合环磷酰胺治疗后病情好转。检索文献后共收集病例1例，为64岁男性，以急性肾衰竭入院，影像学检查发现腹膜后纤维化，肾脏病理提示IgG4相关肾小管间质性肾炎合并IgA肾病，经糖皮质激素治疗后好转，国外并无类似报道。结论积极治疗IgG4相关肾小管间质性肾炎合并IgA肾病患者，可延缓病情进展。

【关键词】免疫球蛋白G4；间质性肾炎；IgA肾病

【Abstract】ObjectiveTo enhance the understanding of immunoglobulin G4（IgG4）-related tubulointerstitial nephritis complicated with IgA nephropathy. MethodsClinical data of one case of IgG4-relatedtubulointerstitial nephritis complicated with IgA nephropathy were collected. Literature review was conducted through PubMed， Wanfang data， CNKI and Chongqing VIP using the key words of IgG4， tubulointerstitial nephritis and IgA nephropathy. ResultsThe male patient was 62 years old. He presented with increased urine during night for 4 years and urine foam for 5 months. He also had increased levels of IgG， IgG4 in the peripheral blood and elevated serum levels of creatinine. He was diagnosed with IgG4-related tubulointerstitial nephritis complicated with IgA nephropathy through renal biopsy. Relevant symptoms were mitigated after combined treatment of glucocorticoids and immune suppressor. Only one similar case was reported in China. A 64-year old man was admitted due to acute renal failure. Imaging finding revealed retroperitoneal fibrosis， whereas renal biopsy prompted the diagnosis of IgG4-related tubulointerstitial nephritis complicated with IgA nephropathy. Relevant symptoms were alleviated after glucocorticoids therapy. No similar case was reported abroad. ConclusionActive and effective therapy should be delivered to prevent the progression of IgG4-related tubulointerstitial nephritis complicated with IgA nephropathy.

【Key words】IgG4；Tubulointerstitial nephritis； IgA nephropathy

IgG4相关肾病（IgG4-RKD），是一种自身免疫介导的炎性纤维化疾病，主要表现为肾小管间质性肾炎（TIN），肾小管间质炎症细胞浸润、萎缩、纤维化。IgG4-RKD极少出现肾实质受累，通过检索国内外文献仅见IgG4-RKD合并IgA肾病、膜性肾病等的个案报道，而有關IgG4-RKD与肾小球疾病之间的相互关系尚无定论。为此，本文报道一例IgG4相关TIN合并IgA肾病患者，并复习相关文献，以提高临床医师对该类疾病的认识水平。

对象与方法

一、1例IgG4相关肾小管间质性肾炎合并IgA肾病患……