目的 总结IgM肾病的临床特点.方法 回顾性分析10例IgM肾病患者的临床资料,总结其临床表现、病理特点、尿足细胞排泄特点、治疗方法及治疗反应.结果 10例患者中9例表现为肾病综合征,1例表现为肾小球肾炎.3例为镜下血尿,无肉眼血尿.病理表现为轻到中度系膜增生,所有患者IgM(++)颗粒状沉积在系膜区.10例患者中9例尿中无足细胞排出,1例有少量排出,为2个/20HP.绝大多数患者对治疗的反应良好,9例完全缓解,1例部分缓解;3例复发.单纯激素治疗、单纯来氟米特治疗或联合治疗有效.结论 IgM肾病患者的临床表现以肾病综合征为主,病理表现为轻到中度系膜增生,所有患者IgM++ 颗粒状沉积在系膜区,尿中无足细胞排出,对激素和免疫抑制剂有良好的反应性.%Objective To observe the clinical features of IgM nephropathy. Methods Retrospective analysis of the clinical manifestations, pathologic features, characteristic of urinary podocyte excretion, treatment method and therapeutic reaction were carried out in 10 patients with IgM nephrology. Results Of the 10 patients ( 6 males and 4 females ), 9 were with ne-phrotic syndrome and one was with glomerulonephritis. Microscopic hematuria was noted in 3 cases and no gross hematuria was noted at all. Pathologic changes were mesangial proliferation of mild to moderate degrees with granular IgM deposit seen in the mesangial areas in all cases. No podocyte excretion was found in 9 out of the 10 cases and minimal excretion was noted in 1 case ( 2/20HP ). Satisfiable treating response was achieved with complete remission occurred in 9 cases, effectiveness in 1 case, and relapse in 3 cases. Treatment with steroids and Lefloumint ( alone or combined ) were all effective. Conclusion Clinical features of IgM nephropathy primarily represent nephrotic syndrome. Pathologic changes are mild to moderate degrees of mesangial proliferation. Granular IgM deposit is seen in mesangial areas in all cases. No podocyte excretion is found in the urine. Satisfiable responses to steroids and immunosuppressants are noted.
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