Zidar N, Ferluga D, Volavsek M, Vizjak A, Luzar S, Kveder R
Institute of Pathology, Medical Faculty, University of Ljubljana, Slovenia.
Kidney Int. 1992 Dec;42(6):1444-9. doi: 10.1038/ki.1992.439.
Kidney biopsies of 425 patients with IgA glomerulonephritis were studied to reveal the incidence, composition and possible clinical significance of extraglomerular vascular immune deposits. IgA deposits were detected in 20 cases, IgM in 28 (in 5 together with IgA), C3 in 317 and no vascular deposits in 60 cases. C3 and IgA deposits were granular, resembling mesangial deposits, while IgM deposits were lumpy, similar to IgM deposits in sclerotic and hyalinized glomeruli. The incidence of vascular lesions in patients with IgA (30%) and C3 deposits (24%) was not significantly higher as compared to those without vascular deposits (20%), but was significantly higher in patients with IgM deposits (68%, P < 0.00004). Only the presence of vascular IgM deposits correlated significantly with severe glomerulosclerosis, arterial hypertension and elevated serum creatinine levels (all P < 0.001). We conclude that neither C3 nor IgA deposits, in spite of their suggested immune complex nature, contribute significantly to the development of vascular lesions. Lumpy IgM deposits, probably the result of insudation of plasma proteins into the blood vessel walls, were associated with advanced vascular lesions and glomerulosclerosis and are probably a part of non-immune mediated progression of IgA glomerulonephritis.
对425例IgA肾小球肾炎患者的肾活检进行研究，以揭示肾小球外血管免疫沉积物的发生率、组成及可能的临床意义。20例检测到IgA沉积物，28例检测到IgM沉积物（其中5例与IgA同时存在），317例检测到C3沉积物，60例未检测到血管沉积物。C3和IgA沉积物呈颗粒状，类似于系膜沉积物，而IgM沉积物呈块状，类似于硬化和透明样变肾小球中的IgM沉积物。与无血管沉积物的患者相比，有IgA沉积物（30%）和C3沉积物（24%）的患者血管病变发生率虽无显著升高（20%），但有IgM沉积物的患者血管病变发生率显著升高（68%，P<0.00004）。仅血管IgM沉积物的存在与严重肾小球硬化、动脉高血压及血清肌酐水平升高显著相关（均P<0.001）。我们得出结论，尽管C3和IgA沉积物提示具有免疫复合物性质，但它们对血管病变的发展均无显著作用。块状IgM沉积物可能是血浆蛋白渗入血管壁的结果，与晚期血管病变和肾小球硬化相关，可能是IgA肾小球肾炎非免疫介导进展的一部分。
