Korean J Nephrol.  2007 Mar;26(2):258-263.

A Case of IgA Nephropathy associated with Disseminated Tuberculosis

• Kim YH
• Roh YS
• Kim EY
• Yi JH
• Son BK
• Han SW
• Park MH
• Kim HJ

Abstract

The cause of IgA nephropathy is unknown, but a mesangial deposition of IgA immune complexes containing antigens from a putative pathogen might be involved in its pathogenesis. We report a case of IgA nephropathy associated with disseminated tuberculosis. A 32-year-old man was presented with sudden onset of edema of both lower legs. The chest X-ray revealed extensive active pulmonary tuberculosis in both lung fields. The abdominal CT, cystoscopy and IVP were compatible with renal tuberculosis and tuberculous cystitis. Besides, the colonoscopic findings with biopsy showed tuberculous colitis. The laboratory data revealed a positive culture for tuberculous bacilli from sputum, 2.7 g of 24-hour urinary protein, and microscopic hematuria. A renal biopsy showed mesangial and segmental endocapillary proliferative glomerulonephritis, consistent with IgA nephropathy. Intense positive stainings for IgA and C3 in the mesangium by Immunofluorescence microscopy. Electron microscopic examination demonstrates segmental endocapillary proliferation, necrosis and mesangiolysis with mild mesangial electron-dense deposits. Treatment with anti-tuberculous medications resulted in gradual disappearance of proteinuria and other various manifestations of the disseminated tuberculosis. Therefore we suggest that IgA nephropathy may be associated with active disseminated tuberculosis.

Keyword

IgA nephropathy; Tuberculosis

MeSH Terms

Adult
Antigen-Antibody Complex
Biopsy
Colitis
Cystitis
Cystoscopy
Edema
Glomerulonephritis
Glomerulonephritis, IGA*
Hematuria
Humans
Immunoglobulin A*
Leg
Lung
Microscopy, Fluorescence
Necrosis
Proteinuria
Sputum
Thorax
Tomography, X-Ray Computed
Tuberculosis*
Tuberculosis, Pulmonary
Tuberculosis, Renal
Antigen-Antibody Complex
Immunoglobulin A