目的：观察IgA型感染后肾小球肾炎（ PIGN）的临床与病理特征，及其与金黄色葡萄球菌感染及潜在糖尿病的相关性。方法回顾性分析IgA型PIGN患者25例，均进行肾组织活检，分析其在光镜病理、免疫荧光显微镜和电子显微镜下变化特点，总结其临床结局。结果所有患者在发病时均为临床金黄色葡萄球菌感染其中MSSA感染11例，MRSA感染14例。肾活检显示：急性期PIGN 6例，表现为弥漫性增生性肾小球肾炎，恢复期或亚急性期显示系膜细胞增生。免疫荧光显示IgA沉积。超微结构分析表明局灶性上皮下驼峰状电子致密物沉积。25例均使用抗生素治疗12例联合应用甲泼尼龙治疗，血液透析依赖8例。其中16例出院，完全缓解6例，部分缓解10例；9例持续住院，死亡5例。结论 IgA型与金黄色葡萄球菌感染有关。诊断主要依靠IgA的免疫荧光染色和存在毛细血管内增殖，电镜检查示上皮下电子致密沉积。%Objective To determine the clinical and pathologic features of IgA dominant post infectious glomerulone -phritis ( PIGN ) , including its association with staphylococcal infections , underlying diabetes , frequency of progression to ESRD, and its pathologic spectrum on renal biopsy .Methods We retrospectively reviewed 25 renal biopsy of PIGN for the past 5 years, and analyzed the pathologic results of light microscopy , immunofluorescence microscopy and electron microsco-py.Their clinical outcomes were also summarized .Results All patients at the onset of clinical are S .aureus infections, among them, MSSA infection were 11 cases, MRSA infection in 14 cases.Renal biopsy showed that:acute phase PIGN 6 ca-ses with diffuse proliferative glomerulonephritis , recovery or subacute phase display mesangial cell proliferation .Immunofluo-rescence showed IgA deposition .Ultrastructural analysis showed that subcutaneous hump-shaped electron dense deposits .25 cases were treated with antibiotics theryapy , 12 cases were treated with antibiotics combined with methylprednisolone therapy , hemodialysis dependent on eight cases .16 patients discharged from hospital , six cases of complete remission , partial remis-sion in 10 cases;nine cases continued hospitalization , 5 patients died .Conclusion IgA dominant post infectious glomerulo-nephritis are associated with Staphylococcal infections .The diagnosis depends on IgA dominant or co-dominant immunofluores-cent staining and the presence of endocapillary proliferation , subepithelial electron dense deposits .
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