Inoue Yoshimoto, Kanda Yoko, Kinoshita Chiharu, Kanda Chiaki, Joh Kensuke
Kyoto Min-iren Chuo Hospital, Kyoto, Japan.
Clin Exp Nephrol. 2008 Dec;12(6):504-8. doi: 10.1007/s10157-008-0101-2. Epub 2008 Nov 13.
A 45-year-old male had proteinuria for 3 years. For persistent proteinuria over 2 g/day, he underwent renal biopsy. Light microscopy revealed focal segmental glomerulosclerosis together with diffuse capillary wall thickening. Periodic acid methenamine silver (PAM) staining showed a prominent bubbly appearance without spike formation could be found in almost all capillary walls. Electron microscopy revealed many microspheres measuring 50-70 nm in diameter distributed in diffuse and global fashion together with the thickened glomerular basement membrane. A few cytoplasmic processes of the podocytes showed infolding to the GBM. The patient exhibited no symptoms and no physical and serological findings suggesting autoimmune disease, such as systemic lupus erythematosus or Sjögren's syndrome. Therefore, the present case is important, because the peculiar microstructure in the GBM was noted in focal segmental glomerulosclerosis, which has never been reported in the literature.
一名45岁男性蛋白尿3年。因持续蛋白尿超过2 g/天，他接受了肾活检。光镜检查显示局灶节段性肾小球硬化伴弥漫性毛细血管壁增厚。高碘酸甲苯胺银（PAM）染色显示几乎所有毛细血管壁均可见明显的泡沫状外观，无钉突形成。电镜检查显示许多直径为50 - 70 nm的微球以弥漫性和全球性方式分布，同时伴有肾小球基底膜增厚。足细胞的一些胞质突起向肾小球基底膜折叠。该患者无任何症状，也无提示自身免疫性疾病（如系统性红斑狼疮或干燥综合征）的体格检查和血清学发现。因此，本病例很重要，因为在局灶节段性肾小球硬化中发现了肾小球基底膜中独特的微观结构，这在文献中从未有过报道。
