Is there a pathogenic association between Fabry’s disease and IgA nephropathy?

Several cases of concurrent Fabry’s disease and IgA nephropathy have been reported, but the pathogenic association between these two diseases remains unclear. This is a report on the case of a girl with severe IgA nephropathy who was subsequently diagnosed with subclinical Fabry’s disease. An 11-year-old girl was admitted to our hospital with massive proteinuria and hematuria detected by urinary screening. An initial renal biopsy revealed severe IgA nephropathy with diffuse mesangial proliferation. She was treated with intravenous methylprednisolone pulses followed by 2 years of oral steroids. The treatment improved both the urinary abnormalities and the second renal biopsy findings. At the age of 15 years, mild proteinuria prompted us to perform a third renal biopsy, and histology revealed minor glomerular abnormalities. In addition, numerous myelin-like bodies were detected in podocytes by electron microscopy. The histological findings combined with the low level of α-galactosidase A activity led to the diagnosis of concomitant Fabry’s disease with IgA nephropathy. Our experience suggests that the initial massive proteinuria was not due to Fabry’s disease, but was rather a manifestation of coincidental IgA nephropathy. We speculate that the coexistence of IgA nephropathy and Fabry’s disease occurred by chance.