Stokes M B, Davis C L, Alpers C E
Division of Nephrology, University of Washington Medical Center, Seattle, WA, USA.
Am J Kidney Dis. 1999 Apr;33(4):658-66. doi: 10.1016/s0272-6386(99)70216-7.
We reviewed the clinical and pathological characteristics of seven patients with collapsing glomerulopathy (CG) in renal allograft biopsy specimens. All patients underwent biopsies for graft dysfunction. Two patients had nephrotic proteinuria (protein, >3.5 g/24 h), whereas all others had only modest or insignificant proteinuria. In five of seven patients, additional pathological processes, including microvascular injury, acute rejection, recurrent diabetic nephropathy, and immune complex glomerulonephritis, were present, each of which likely contributed to graft dysfunction and proteinuria. None of the patients in this series had nephrotic syndrome solely attributable to CG. Three biopsy specimens had features consistent with chronic rejection. The development of CG in renal allograft biopsy specimens was associated with graft dysfunction and a high rate of graft loss. These findings emphasize the prognostic significance of CG in renal allografts and suggest that CG may result from diverse pathogenic mechanisms.
我们回顾了7例肾移植活检标本中出现塌陷性肾小球病（CG）患者的临床和病理特征。所有患者均因移植肾功能障碍接受活检。2例患者有肾病性蛋白尿（蛋白>3.5g/24小时），而其他患者仅有轻度或少量蛋白尿。7例患者中有5例存在其他病理过程，包括微血管损伤、急性排斥反应、复发性糖尿病肾病和免疫复合物性肾小球肾炎，每一种病理过程都可能导致移植肾功能障碍和蛋白尿。本系列患者中无一例肾病综合征仅归因于CG。3份活检标本具有与慢性排斥反应一致的特征。肾移植活检标本中CG的发生与移植肾功能障碍和高移植丢失率相关。这些发现强调了CG在肾移植中的预后意义，并提示CG可能由多种致病机制引起。
