Zusammenfassung
Anamnese und klinischer Befund: Ein
36-jähriger Patient stellte sich mit rezidivierenden exsudativen
Pleuraergüssen vor. Beim ersten Auftreten der Pleuraergüsse
fand sich eine Niereninsuffizienz (Serum-Kreatinin 1,9 mg/dl)
mit glomerulärer Erythrozyturie, Proteinurie und renaler
Hypertonie.
Untersuchungen: Die Nierenbiopsie erbrachte eine
mesangioproliferative Glomerulonephritis; immunhistologisch fanden
sich mesangiale IgA- Ablagerungen. Die Niereninsuffzienz zeigte
unter konsequenter Blutdruckkontrolle keine Progredienz. Die Klärung
der Pleuritisursache gestaltete sich trotz umfangreicher Diagnostik schwierig.
Erst durch den Einsatz eines Interferon Gamma Release Assays (IGRA)
gelang der Nachweis einer Pleuritis tuberculosa.
Therapie und Verlauf: Unter antituberkulotischer
Therapie bildeten sich die Pleuraergüsse dauerhaft zurück.
Nach 8 Wochen Therapie wurden eine anhaltende Normalisierung der
Nierenfunktion (eGFR > 75 ml/min),
Rückbildung der Erythrozyturie und Verminderung der Proteinurie
beobachtet.
Folgerung: Dieser Fallbericht einer
partiellen Remission einer IgA-Nephropathie bei Heilung einer Pleuritis
tuberculosa bestätigt die These eines kausalen Zusammenhanges
zwischen mykobakteriellen Infektionen und IgA-Nephropathie.
Abstract
History and clinical findings: A 36-year-old
patient suffered from repeated exsudative pleural effusions and
renal insufficiency (serum creatinine 1.9 mg/dl)
combined with glomerular erythrocyturia, proteinuria and renal hypertension.
Investigations: The diagnosis of the
underlying etiology of the pleural effusions was difficult in spite
of a thorough diagnostic work-up. Pleural tuberculosis was finally
detected by an interferon gamma release assay (IGRA). Kidney biopsy
revealed mesangioproliferative glomerulonephritis, immunhistology showed
mesangial IgA deposits. Renal insufficiency did not progress when
blood pressure control was achieved.
Treatment and clinical course: The pleural
effusions resolved permanently when antituberculous treatment was
begun. Eight weeks after initiation of therapy normalization of
kidney function (eGFR > 75 ml/min),
resolution of hematuria and reduction of proteinuria were observed.
Conclusions: This report of a partial
remission of IgA nephropathy by treatment of pleural tuberculosis
supports the hypothesis that there may be a causal relationship
between mycobacterial infections and IgA nephropathy.
Schlüsselwörter
IgA-Nephritis - Tuberkulose - interferon gamma release assay - Pleuraerguss
Keywords
IgA nephropathy - tuberculosis - interferon gamma release assay - pleural effusion
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Prof. Dr. Susanne M. Lang
SRH Wald-Klinikum Gera GmbH, 2. Medizinische
Klinik
Straße des Friedens 122
07548
Gera
Phone: 03658282150
Fax: 03658282196
Email: lang_susanne@hotmail.com
