Moudgil A, Nast C C, Bagga A, Wei L, Nurmamet A, Cohen A H, Jordan S C, Toyoda M
Department of Pediatrics, Division of Transplant Immunology, Steven Spielberg Pediatric Research Center, UCLA School of Medicine, Los Angeles, California, USA.
Kidney Int. 2001 Jun;59(6):2126-33. doi: 10.1046/j.1523-1755.2001.00727.x.
Collapsing glomerulopathy (CG), a disorder with severe glomerular and tubular involvement, occurs either as an idiopathic lesion or in some patients with human immunodeficiency virus (HIV) infection known as HIV-associated nephropathy (HIVAN). We previously reported a renal transplant recipient with de novo CG and red cell aplasia in association with persistent parvovirus B19 (PVB19) infection. This prompted us to look for an association between PVB19 infection and CG.
DNA from archived biopsies of patients with CG was analyzed for PVB19 by polymerase chain reaction (PCR). Results were compared with HIVAN, idiopathic focal segmental glomerulosclerosis (FSGS), and controls. In situ hybridization (ISH) was done to localize PVB19 in renal biopsies. Peripheral blood specimens of patients with CG, HIV infection, healthy controls, and randomly selected hospitalized patients (sick controls) were also analyzed for PVB19.
PVB19 DNA was detected in renal biopsies of 18 out of 23 (78.3%) patients with CG, 3 out of 19 (15.8%) with HIVAN, 6 out of 27 (22.2%) with FSGS, and 7 out of 27 (25.9%) controls (P < 0.01, CG vs. HIVAN, FSGS, and controls). PVB19 was detected in peripheral blood of 7 out of 8 (87.5%) CG patients, 3 out of 22 (13.6%) with HIV infection, 4 out of 133 (3%) healthy controls, and 2 out of 50 (4%) sick controls (P < 0.001, CG vs. HIV infected, healthy, and sick controls). PVB19 was identified in glomerular parietal and visceral epithelial and tubular cells by ISH.
The significantly higher prevalence of PVB19 DNA in renal biopsies and peripheral blood of CG patients suggests a specific association between PVB19 infection and CG. In susceptible individuals, renal epithelial cell infection with PVB19 may induce CG.
塌陷性肾小球病（CG）是一种伴有严重肾小球和肾小管受累的疾病，可作为特发性病变出现，或在一些人类免疫缺陷病毒（HIV）感染患者中发生，称为HIV相关性肾病（HIVAN）。我们之前报道了一名肾移植受者发生了新发CG和红细胞再生障碍，并伴有持续性细小病毒B19（PVB19）感染。这促使我们去寻找PVB19感染与CG之间的关联。
通过聚合酶链反应（PCR）分析CG患者存档活检组织中的DNA以检测PVB19。将结果与HIVAN、特发性局灶节段性肾小球硬化（FSGS）及对照组进行比较。进行原位杂交（ISH）以在肾活检组织中定位PVB19。还对CG患者、HIV感染患者、健康对照者及随机选择的住院患者（患病对照者）的外周血标本进行PVB19分析。
在23例CG患者中的18例（78.3%）肾活检组织中检测到PVB19 DNA，19例HIVAN患者中的3例（15.8%），27例FSGS患者中的6例（22.2%），以及27例对照者中的7例（25.9%）（P<0.01，CG与HIVAN、FSGS及对照者相比）。在8例CG患者中的7例（87.5%）外周血中检测到PVB19，22例HIV感染患者中的3例（13.6%），133例健康对照者中的4例（3%），以及50例患病对照者中的2例（4%）（P<0.001，CG与HIV感染、健康及患病对照者相比）。通过ISH在肾小球壁层和脏层上皮细胞及肾小管细胞中鉴定出PVB19。
CG患者肾活检组织和外周血中PVB19 DNA的患病率显著更高，提示PVB19感染与CG之间存在特定关联。在易感个体中，PVB19感染肾上皮细胞可能诱发CG。
