Toth T, Takebayashi S
Second Department of Pathology, Medical School, Fukuoka University, Japan.
Clin Nephrol. 1992 Jul;38(1):14-9.
We evaluated clinical and morphological findings in 254 patients (138 men and 116 women), with idiopathic membranous glomerulonephritis (IMGN). The mean age was 44 years. At time of biopsy proteinuria was found in 98%, nephrotic syndrome (NS) in 45.2%, hypertension in 10%, elevated serum creatinine concentration of greater than or equal to 1.4 g/dl in 24%, and markedly decreased Ccr (less than or equal to 40 ml/min) in 12.5% of the patients. Of 254 patients, 51 (20%) were classified as Stage I, 131 (52%) as Stage II, 52 (20.5%) as Stage III, 9 (3.5%) as Stage IV and 11 (4.3%) as Stage V, which was a relapsing form. Both intraglomerular, peripheral electron dense deposit-size and mean thickness of the glomerular basement membrane (GBMt) were analyzed by ultrastructural morphometric methods. In patients with NS, both the mean deposit-size and the mean GBMt were largest when compared to all others (p less than 0.01). The largest subepithelial deposits (SED), in mean, were observed in Stages II and V, while the largest incorporated deposits (ICD) were measured in Stages II and IV. The mean GBMt was largest in Stage III. Furthermore, there were strong correlations between the degree of proteinuria and the deposit-size (r = 0.603, p less than 0.001), and GBMt (r = 0.456, p less than 0.001). The GBMt showed a correlation with serum creatinine concentration (r = 0.476, p less than 0.001) and Ccr (r = 0.471, p less than 0.001). We concluded that the size of the electron dense deposits and GBM thickness play an important role in the clinical manifestation of IMGN.
我们评估了254例特发性膜性肾小球肾炎（IMGN）患者（138例男性和116例女性）的临床和形态学表现。平均年龄为44岁。活检时，98%的患者存在蛋白尿，45.2%的患者患有肾病综合征（NS），10%的患者有高血压，24%的患者血清肌酐浓度升高至大于或等于1.4 g/dl，12.5%的患者肌酐清除率（Ccr）显著降低（小于或等于40 ml/min）。在254例患者中，51例（20%）被分类为I期，131例（52%）为II期，52例（20.5%）为III期，9例（3.5%）为IV期，11例（4.3%）为V期（复发型）。通过超微结构形态计量学方法分析了肾小球内、外周电子致密沉积物大小和肾小球基底膜（GBMt）的平均厚度。在患有NS的患者中，与所有其他患者相比，平均沉积物大小和平均GBMt均最大（p<0.01）。平均而言，最大的上皮下沉积物（SED）见于II期和V期，而最大的内吞沉积物（ICD）见于II期和IV期。III期的平均GBMt最大。此外，蛋白尿程度与沉积物大小（r = 0.603，p<0.001）以及GBMt（r = 0.456，p<0.001）之间存在强相关性。GBMt与血清肌酐浓度（r = 0.476，p<0.001）和Ccr（r = 0.471，p<0.001）相关。我们得出结论，电子致密沉积物的大小和GBM厚度在IMGN的临床表现中起重要作用。
