A case of immunoglobulin A nephropathy with a long history (32 years) in the relatively poor prognosis group

Abstract We report herein an immunoglobulin A nephropathy patient with a long history of 32 years in the relatively poor prognosis group according to pathological findings. In general, such cases in the relatively poor prognosis group develop end-stage renal failure, and undergo dialysis within 5 to 20 years. However, the period from the appearance of proteinuria to hemodialysis was very long in this patient. His mean blood pressure remained at approximately 100 mm Hg with the administration of some antihypertensive agent. The genotype of the angiotensin converting enzyme was II. Although normal renal function continued for the duration, he had severe acute tonsillitis at 45 and 49 years of age. After these infections, proteinuria and/or hematuria were exacerbated and he gradually progressed to end-stage renal failure. The good prognosis in this patient might be attributable to good control of blood pressure, whereas the decline in renal function might be attributable to severe recurrent upper respiratory tract infection. It seems that control of blood pressure and prevention of recurrent upper respiratory tract infection are important factors in the prognosis of patients with immunoglobulin A nephropathy. Although the association between angiotensin converting enzyme genotype and prognosis of immunoglobulin A nephropathy is controversial, it is postulated that angiotensin converting enzyme genotype II might be correlated with the good prognosis in this case.