A case of psoriasis vulgaris associated with IgA nephropathy improved clinically in response to plasmapheresis.
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We report a case of psoriasis vulgaris associated with IgA nephropathy, in which the psoriasis and proteinuria improved in response to plasmapheresis. This 41-year-old male has been under the care of a dermatologist for psoriasis vulgaris since 1982. Proteinuria was first discovered at an annual check-up in 1986, but the patient did not undergo complete medical examination. In April, 1989, he was admitted to Hiroshima University Hospital for careful examination. Physical examination at the time of admission revealed psoriatic skin lesions on his head, back, and the extensor surface of his extremities. Laboratory findings on admission: Urinalysis revealed (++) protein and (+) blood on dipstick examination. Twenty-four-hour urine contained 1.7 grams of protein. BUN was 18 mg/dl, Cr 1.12mg/dl. PSP test 15'35%, CCr 72.5ml/min, and serum IgA 475mg/dl. Renal biopsy results: Light microscopy revealed mild mesangial cell proliferation. Immunofluorescent examination of the renal biopsy demonstrated the presence of IgA and C3 in the mesangium of all glomeruli. Electron microscopy revealed mesangial and paramesangial dense deposits. As a result we diagnosed the case as IgA nephropathy. The psoriasis and proteinuria improved after 3 sessions of plasmapheresis. Psoriasis vulgaris is a chronic skin disease of unknown origin characterized by increased proliferation of epidermal cells with repeated remission and recurrence. An immune abnormality has been reported in this disease. It is also believed that an immune mechanism has some relation to the pathogenesis and progression of IgA nephropathy. Very few investigators, however, have reported an association between psoriasis vulgaris and IgA nephropathy in which plasmapheresis was the treatment. This case may be of interest in terms of the pathogenesis of IgA nephropathy.
- 社団法人 日本透析医学会の論文
社団法人 日本透析医学会 | 論文
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