Sumida K, Ubara Y, Hoshino J, Suwabe T, Nakanishi S, Hiramatsu R, Hasegawa E, Hayami N, Yamanouchi M, Sawa N, Takemoto F, Takaichi K, Oohashi K
Nephrology Center and Department of Pathology, Toranomon Hospital Kajigaya, Kanagawa, Japan.
Clin Nephrol. 2010 Dec;74(6):446-56.
Although hepatitis C virus (HCV) infection is known to be associated with Type 2 cryoglobulinemic glomerulopathy (CG), only a few reports about other types of nephropathy have been published.
68 HCV antibody positive patients in whom renal biopsy had been performed for persistent proteinuria, hematuria, and/or renal dysfunction between 1992 and 2008 at our institute were included. The histological, clinical and laboratory characteristics including the age, gender, hypertension, diabetes mellitus, liver histology (chronic hepatitis or liver cirrhosis), HCV-RNA, HCV genotype, splenomegaly, gastroesophageal varices, serum creatinine, hemoglobin, platelet count, rheumatoid factor, cryoglobulin, IgG, IgA, IgM, CH50, C3, C4, creatinine clearance, 24-h protein excretion, and hematuria, between their nephropathy with and without immune deposition were compared.
Nephropathy was classified into two groups based on the detection of immune deposits by immunofluorescence microscopy: i.e., a positive group (n = 39) and a negative group (n = 29). The former group was further classified into three types of nephropathy: IgG dominant group (n = 10) (including membranous nephropathy (MN)), IgA dominant group (n = 20) (including IgA nephropathy (IgAN)), membranoproliferative glomerulonephritis (MPGN) (IgA type)), and IgM dominant group (n = 9) (MPGN apart from the IgA type). The latter group included diabetic nephropathy (n = 13), focal glomerular sclerosis (n = 4), and benign nephrosclerosis (n = 3), malignant nephrosclerosis (n = 1), tubulointerstitial nephritis (TIN) (n = 2), minimal change nephrotic syndrome (n = 1), cast nephropathy (n = 1), granulomatous TIN (n = 1), and others (n = 3). An increased serum IgM level, hypocomplementemia, splenomegaly, thrombocytopenia, liver cirrhosis, hematuria, and a high HCV RNA level were features of patients with MPGN of IgM dominant group (consistent with "CG").
Our results showed various histological patterns of HCV-related kidney disease and the specificity of CG, and revealed that a minority of HCV patients (n = 7) presented typical CG, while IgAN, MN, and diabetic nephropathy were more frequent.
尽管已知丙型肝炎病毒（HCV）感染与2型冷球蛋白血症性肾小球病（CG）相关，但关于其他类型肾病的报道却很少。
纳入了1992年至2008年间在我院因持续性蛋白尿、血尿和/或肾功能不全而接受肾活检的68例HCV抗体阳性患者。比较了他们有免疫沉积和无免疫沉积的肾病之间的组织学、临床和实验室特征，包括年龄、性别、高血压、糖尿病、肝脏组织学（慢性肝炎或肝硬化）、HCV-RNA、HCV基因型、脾肿大、胃食管静脉曲张、血清肌酐、血红蛋白、血小板计数、类风湿因子、冷球蛋白、IgG、IgA、IgM、CH50、C3、C4、肌酐清除率、24小时蛋白排泄量和血尿情况。
根据免疫荧光显微镜下免疫沉积物的检测结果，将肾病分为两组：即阳性组（n = 39）和阴性组（n = 29）。前一组进一步分为三种肾病类型：IgG为主型组（n = 10）（包括膜性肾病（MN））、IgA为主型组（n = 20）（包括IgA肾病（IgAN））、膜增生性肾小球肾炎（MPGN）（IgA 型））和IgM为主型组（n = 9）（非IgA 型MPGN）。后一组包括糖尿病肾病（n = 13）、局灶性节段性肾小球硬化（n = 4）、良性肾硬化（n = 3）、恶性肾硬化（n = 1）、肾小管间质性肾炎（TIN）（n = 2）、微小病变肾病综合征（n = 1）、管型肾病（n = 1）、肉芽肿性TIN（n = 1）及其他（n = 3）。血清IgM水平升高、补体血症、脾肿大、血小板减少、肝硬化、血尿和高HCV RNA水平是IgM为主型MPGN患者的特征（与“CG”一致）。
我们的结果显示了HCV相关肾脏疾病的各种组织学模式及CG的特异性，揭示了少数HCV患者（n = 7）表现为典型的CG，而IgAN、MN和糖尿病肾病更为常见。
