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中年女性,首诊临床表现少量蛋白尿及镜下血尿,轻度贫血,血压、肾功能、补体及血轻链正常;肾活检示肾小球重度系膜增生性病变伴C3沉积。近5月病情加重,出现中~大量尿蛋白伴镜下血尿,血清肌酐逐步升高,血压升高,补体轻度下降,贫血加重,血轻链κ/λ比例增高,血清免疫固定电泳未见单克隆免疫球蛋白条带,骨髓活检和骨髓细胞学检查均阴性,重复肾活检组织学改变为肾小球膜增生样病变,免疫荧光单克隆Ig G3-κ沉积,电镜观察以肾小球系膜区及基膜内皮下电子致密物沉积为主,上皮侧偶见电子致密物沉积,致密物中未见特殊结构,最终诊断为单克隆Ig G沉积的增生性肾小球肾炎(Ig G3-κ型)。
Middle-aged women, the first clinical manifestations of small amounts of proteinuria and microscopic hematuria, mild anemia, blood pressure, renal function, complement and blood light chain normal; renal biopsy showed severe mesangial proliferative glomerular lesions with C3 deposition. Nearly 5 months aggravating, appeared in a large amount of urine protein with hematuria, serum creatinine gradually increased, blood pressure, mildly decreased complement, anemia, blood light chain kappa / lambda ratio increased, no serum immunostaining electrophoresis Monoclonal immunoglobulin bands, bone marrow biopsy and bone marrow cytology were negative, histological changes of renal biopsy to mesangial proliferative-like lesions, immunofluorescence monoclonal Ig G3-κ deposition, electron microscopy to glomerular Membrane and submucosal electron dense deposition of the basement membrane, the occasional epithelial epithelial deposition of electron-dense material, no special structure in the dense, eventually diagnosed as monoclonal Ig G deposition of proliferative glomerulonephritis (Ig G3- κ type).