Abstract
A 3-year-old boy presented nephrotic syndrome with macroscopic hematuria, without hypocomplementemia was reported. By light microscopy, the renal biopsy revealed diffuse mesangial expansion with mesangial hypercellularity. By immunofluorescence, intense granular deposits of IgG, IgA, C3 and fibrinogen along the glomerular capillary wall were found. By electron microscopy, prominent subepithelial, subendothelial and some mesangial deposits were observed. Mesangial interposition was also observed. There was a significant effacement of foot processes. There was no serological or clinical evidence of collagen disease. He was treated with steroid pulse therapy (30mg/kg intravenous mehtylprednisolone for 3 alternate-days a week, for three cycles, followed by oral prednisolone), immunosuppressant (mizoribine), angiotensin-converting enzyme inhibitor (enalapril) and angiotensin-II receptor antagonist (losartan). The proteinuria and hematuria were reduced but persisted. Although histopathological studies were compatible with secondary membranous nephropathy or membranoproliferative glomerulonephritis type III, IgA deposition along glomerular capillary wall is unusual in such diseases. We assume this is a rare form of primary MPGN type III with capillary IgA deposition.
