Korean J Nephrol.  2009 Mar;28(2):152-156.

A Case of IgA Nephropathy with a Membranoproliferative Glomerulonephritis-like Pattern Presenting as Massive Ascites in a Patient with Alcoholic Liver Disease

• Song SO
• Lee SW
• Lee HW
• Kang BD
• Dong SH
• Choi JS
• Song JS
• Yoon SY
• Lee SC

Abstract

IgA nephropathy can occur commonly in alcoholic liver cirrhosis and is the most common form of secondary IgA nephropathy. Defective clearance of IgA-containing complexes by liver is thought to contribute to the development of IgA nephropathy in alcoholic cirrhosis. Although IgA deposition is found up to 64% in autopsy cases of alcoholic cirrhosis, most patients have mild clinical symptoms, and nephrotic range proteinuria occurs rarely in these patients. We report a case of IgA nephropathy with a membranoproliferative pattern that is detected with unusual massive ascites in a patient with alcoholic liver disease. A 60-year-old male patient was referred to our hospital for evaluation and management of abdominal distension. Abdominal ultrasonographic findings were compatible with diffuse liver cirrhosis with splenomegaly and large amount of ascites. He had nephrotic range proteinuria, azotemia, hyperlipidemia, and hematuria in dipstick. Renal biopsy performed under the impression of acute nephritis revealed mesangial and endocapillary proliferative glomerulonephritis with double contour of capillary loop. Immunofluorescence findings showed mesangial IgA and C3 deposit, compatible with IgA nephropathy. He was treated with high dose steroid, and steroid was tapered during 2 months. Steroid treatment induced complete remission state, and ascites was resolved.

Keyword

IgA nephropathy; Membranoproliferative glomerulonephritis; Ascites; Alcoholic liver disease

MeSH Terms

Alcoholics
Ascites
Autopsy
Azotemia
Biopsy
Capillaries
Fluorescent Antibody Technique
Glomerulonephritis
Glomerulonephritis, IGA
Glomerulonephritis, Membranoproliferative
Hematuria
Humans
Hyperlipidemias
Immunoglobulin A
Liver
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Liver Diseases, Alcoholic
Male
Middle Aged
Nephritis
Proteinuria
Splenomegaly
Immunoglobulin A