Ieiri N, Hotta O, Taguma Y
Department of Nephrology, Sendai Shakaihoken Hospital, Sendai, Miyagi, Japan.
Clin Nephrol. 2005 Oct;64(4):249-57. doi: 10.5414/cnp64249.
Acute glomerulonephritis (AGN) is a rare complication of human parvovirus B19 (HPB19) infection. The clinical and pathological features of AGN associated with HPB19 (HPBAGN) have not yet been fully elucidated.
We analyzed 10 HPBAGN cases, focusing on their clinical and serological features. We also performed histopathological examinations of renal biopsy specimens obtained from three of the 10 patients on day 15, 19 and 23, respectively, after the onset of symptoms. The phenotype of the glomerular infiltrating leukocytes in HPBAGN was determined by immunohistochemical staining and compared with that of glomerular infiltrating leukocytes in poststreptococcal AGN (PSAGN) and lupus nephritis.
The clinical course and laboratory data of the HPBAGN patients revealed female preponderance (male = 0, female = 10), erythema in 9 of the 10 patients, leukopenia in 3, positive antinuclear antibody titer in 4, hypocomplementemia with low levels of C3, C4, and CH50 in 9, and liver dysfunction in 7. Endocapillary hypercellularity of leukocytes was demonstrated in all three patients who underwent renal biopsy. In comparison with PSAGN and lupus nephritis with crescents there were less neutrophil in HPBAGN compared to marked macrophage infiltrates that were equally intense in both the control and the HPBAGN group.
Our findings indicate that HPBAGN is characterized by female preponderance, erythema, leukopenia, positive antinuclear antibody titer, and hypocomplementemia, and that minor neutrophil infiltration may be related to mild clinical manifestations despite the marked fixation of glomerular leukocytes in HPBAGN.
急性肾小球肾炎（AGN）是人类细小病毒B19（HPB19）感染的一种罕见并发症。与HPB19相关的AGN（HPBAGN）的临床和病理特征尚未完全阐明。
我们分析了10例HPBAGN病例，重点关注其临床和血清学特征。我们还对10例患者中的3例在症状出现后第15天、19天和23天分别获取的肾活检标本进行了组织病理学检查。通过免疫组织化学染色确定HPBAGN中肾小球浸润白细胞的表型，并与链球菌感染后AGN（PSAGN）和狼疮性肾炎中肾小球浸润白细胞的表型进行比较。
HPBAGN患者的临床病程和实验室数据显示女性占优势（男性 = 0，女性 = 10），10例患者中有9例出现红斑，3例白细胞减少，4例抗核抗体滴度阳性，9例补体降低，C3、C4和CH50水平低，7例肝功能障碍。接受肾活检的所有3例患者均显示白细胞毛细血管内细胞增多。与有新月体的PSAGN和狼疮性肾炎相比，HPBAGN中的中性粒细胞较少，而对照组和HPBAGN组中巨噬细胞浸润同样明显。
我们的研究结果表明，HPBAGN的特征是女性占优势、红斑、白细胞减少、抗核抗体滴度阳性和补体降低，并且尽管HPBAGN中肾小球白细胞明显固定，但轻微的中性粒细胞浸润可能与轻微的临床表现有关。
