Kiyama S, Sakemi T, Shimokama T, Baba N, Watanabe T
Department of Internal Medicine, Saga Medical School, Japan.
Jpn J Med. 1991 May-Jun;30(3):238-42. doi: 10.2169/internalmedicine1962.30.238.
A case of crescentic glomerulonephritis associated with renal amyloidosis is reported. A 62-year-old woman with a 6-yr history of rheumatoid arthritis developed rapidly progressive glomerulonephritis associated with renal amyloidosis and crescent formation. Amyloid protein was positively stained with anti-AA antibody and its fibrils were demonstrated by electron microscopy. In connection with epithelial cell proliferation in the capsular space, destruction of the capillary basement membrane was observed at the sites where amyloid fibrils were accumulated, whereas glomerular deposition of immunoglobulin and complement was not detected. It is conceivable that the destruction of the glomerular tufts induced by amyloid deposition may be responsible for the crescent formation.
报告了一例与肾淀粉样变性相关的新月体性肾小球肾炎病例。一名患有6年类风湿关节炎病史的62岁女性发生了与肾淀粉样变性和新月体形成相关的快速进展性肾小球肾炎。淀粉样蛋白用抗AA抗体呈阳性染色,其纤维通过电子显微镜证实。与肾小囊腔内的上皮细胞增殖相关,在淀粉样纤维聚集的部位观察到毛细血管基底膜的破坏,而未检测到免疫球蛋白和补体的肾小球沉积。可以想象,淀粉样沉积诱导的肾小球丛破坏可能是新月体形成的原因。