Resolution of Henoch-Schönlein purpura nephritis after acquired IgA deficiency.
We report a case of Henoch-Schönlein purpura nephritis (HSPN) with acquired IgA deficiency due to parvovirus B19 infection. The patient was diagnosed as having Henoch-Schönlein purpura (HSP) at 6 years old, and subsequently developed macrohematuria and massive proteinuria of 7.4 g/day with decreased creatinine clearance of 70.2 ml/min/1.73 m(2) and significantly elevated serum IgA level of 449 mg/dl. The first kidney biopsy yielded the diagnosis of severe HSPN. After the initiation of the immunosuppressive therapy, the patient was infected with parvovirus B19 and developed virus-associated hemophagocytic syndrome (VAHS). Thereafter, the serum level of IgA selectively decreased and remained undetectable until the present time. Repeated kidney biopsies performed over a period of 14 years revealed a remarkable histological improvement in association with stabilization of the patient's kidney function. Considering the severity of initial kidney injury, persistent acquired IgA deficiency was likely to add favorable effects to the immunosuppressive therapy in this patient with HSPN.
Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. motanaka@mitsuihosp.or.jp
Mototsugu
M
Tanaka
George
G
Seki
Kenichi
K
Ishizawa
Junichi
J
Hirahashi
Kenichiro
K
Miura
Takashi
T
Sekine
Tomonosuke
T
Someya
Hiroshi
H
Hataya
Michio
M
Nagata
Toshiro
T
Fujita
D001706:Biopsy; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D017098:IgA Deficiency / Q000150:complications*; D011695:IgA Vasculitis / Q000150:complications* / Q000473:pathology / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology / Q000601:surgery; D009393:Nephritis / Q000150:complications / Q000188:drug therapy*; D016732:Parvovirus B19, Human / Q000302:isolation & purification; D011507:Proteinuria / Q000209:etiology; D055815:Young Adult
D007166:Immunosuppressive Agents