Lai F M, Li P K, Suen M W, Lui S F, Lai K N
Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin.
Mod Pathol. 1992 May;5(3):262-7.
Crescentic glomerulonephritis was diagnosed in two chronic hepatitis B surface antigen carriers. In all three biopsies performed, hepatitis B e antigen was found in glomerular capillary tufts. The first patient presented with nephrotic syndrome and acute renal failure. The glomerular pathology revealed crescentic glomerulonephritis with endocapillary proliferation, and she recovered spontaneously with normal renal function over the following 6 mo despite a persistent hepatitis B surface antigenemia. The other patient presented with nephrotic syndrome and normal renal function. Hepatitis B virus-related membranous nephropathy was diagnosed on the first biopsy, and he did well on symptomatic treatment for 20 mo. The nephrotic syndrome recurred and subsequently he developed acute renal failure a month following interferon treatment. The repeated biopsy revealed a crescentic glomerulonephritis that was associated with mixed membranous and membranoproliferative glomerulopathies. This patient responded to immunosuppression and plasma exchange with residual impairment of renal function. He has been stable after 18 mo follow-up.
两名慢性乙型肝炎表面抗原携带者被诊断为新月体性肾小球肾炎。在所有进行的三次活检中，均在肾小球毛细血管袢中发现乙型肝炎e抗原。首例患者表现为肾病综合征和急性肾衰竭。肾小球病理显示为伴有毛细血管内增生的新月体性肾小球肾炎，尽管持续存在乙型肝炎表面抗原血症，但在接下来的6个月内肾功能恢复正常，患者自发康复。另一例患者表现为肾病综合征且肾功能正常。首次活检诊断为乙型肝炎病毒相关性膜性肾病，他接受对症治疗20个月，病情良好。肾病综合征复发，随后在干扰素治疗1个月后出现急性肾衰竭。重复活检显示为新月体性肾小球肾炎，伴有膜性和膜增生性肾小球病混合存在。该患者对免疫抑制和血浆置换治疗有反应，但仍遗留肾功能损害。随访18个月后病情稳定。
