EVOLUTION OF IMMUNOGLOBULIN-A NEPHROPATHY INTO HENOCH-SCHONLEIN PURPURA IN AN ADULT PATIENT

We report the first case of the evolution of immunoglobulin A (IgA) ne phropathy into Henoch-Schonlein purpura in an adult patient. A 28-year -old man presented with an episode of gross hematuria and acute renal failure. The serum IgA level was increased and renal biopsy findings w ere diagnostic of IgA nephropathy. In addition, many renal tubuli were filled by red blood cell casts and presented a marked tubular necrosi s. Coincidental with the disappearance of gross hematuria, renal funct ion progressively improved. The patient continued to have microhematur ia, normal renal function, and isolated bouts of macroscopic hematuria . Ten years later, the patient developed arthralgias, a purpuric rash in the legs, gross hematuria, and an elevated serum creatinine level. A skin biopsy showed leukocytoclastic vasculitis with IgA deposits. Th e renal biopsy showed histologic lesions very similar to those observe d in the first biopsy 10 years before: mesangial proliferation with me sangial deposition of IgA and tubular necrosis with obstruction of ren al tubuli by red blood cell casts The serum creatinine level returned to normal. Recurrent episodes of purpura associated with macroscopic h ematuria persisted during the follow-up, but without worsening of rena l function. An interesting feature of our patient was the development of reversible renal failure associated with macroscopic hematuria on t wo different occasions. Although this complication has been described in IgA nephropathy, it has been rarely reported in Henoch-Schonlein pu rpura. It is possible that IgA nephropathy and Henoch-Schonlein purpur a are different clinical manifestations of the same disease and probab ly share a common pathogenesis. Our case is a demonstrative example of this hypothesis. (C) 1995 by the National Kidney Foundation, Inc.