HISTORY AND CLINICAL FINDINGS: A 36-year-old patient suffered from repeated exsudative pleural effusions and renal insufficiency (serum creatinine 1.9 mg/dl) combined with glomerular erythrocyturia, proteinuria and renal hypertension. INVESTIGATIONS: The diagnosis of the underlying etiology of the pleural effusions was difficult in spite of a thorough diagnostic work-up. Pleural tuberculosis was finally detected by an interferon gamma release assay (IGRA). Kidney biopsy revealed mesangioproliferative glomerulonephritis, immunhistology showed mesangial IgA deposits. Renal insufficiency did not progress when blood pressure control was achieved. TREATMENT AND CLINICAL COURSE: The pleural effusions resolved permanently when antituberculous treatment was begun. Eight weeks after initiation of therapy normalization of kidney function (eGFR > 75 ml/min), resolution of hematuria and reduction of proteinuria were observed. CONCLUSIONS: This report of a partial remission of IgA nephropathy by treatment of pleural tuberculosis supports the hypothesis that there may be a causal relationship between mycobacterial infections and IgA nephropathy. Georg Thieme Verlag KG Stuttgart New York.
HISTORY AND CLINICAL FINDINGS: A 36-year-old patient suffered from repeated exsudative pleural effusions and renal insufficiency (serum creatinine 1.9 mg/dl) combined with glomerular erythrocyturia, proteinuria and renal hypertension. INVESTIGATIONS: The diagnosis of the underlying etiology of the pleural effusions was difficult in spite of a thorough diagnostic work-up. Pleural tuberculosis was finally detected by an interferon gamma release assay (IGRA). Kidney biopsy revealed mesangioproliferative glomerulonephritis, immunhistology showed mesangial IgA deposits. Renal insufficiency did not progress when blood pressure control was achieved. TREATMENT AND CLINICAL COURSE: The pleural effusions resolved permanently when antituberculous treatment was begun. Eight weeks after initiation of therapy normalization of kidney function (eGFR > 75 ml/min), resolution of hematuria and reduction of proteinuria were observed. CONCLUSIONS: This report of a partial remission of IgA nephropathy by treatment of pleural tuberculosis supports the hypothesis that there may be a causal relationship between mycobacterial infections and IgA nephropathy. Georg Thieme Verlag KG Stuttgart New York.