Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Am Soc Nephrol. 2011 Oct;22(10):1804-8. doi: 10.1681/ASN.2010090923. Epub 2011 Sep 8.
Membranous nephropathy is a common cause of nephrotic syndrome in adults and can be primary or secondary to systemic lupus erythematosus, chronic infection, or drugs. Rapid decline in renal function in patients with membranous nephropathy may be due to renal vein thrombosis, malignant hypertension, or an additional superimposed destructive process involving the renal parenchyma. Crescents are rare in primary membranous nephropathy and thus suggest another underlying disease process, such as combined membranous and focal or diffuse lupus nephritis. However, in some patients with membranous nephropathy and crescents, the crescentic lesion may be due to a distinct, separate disease process, such as anti-glomerular basement membrane antibodies or anti-neutrophil cytoplasmic antibodies-related pauci-immune glomerulonephritis. Here we describe a case with such renal biopsy findings, review previous reported cases, and discuss possible implications for pathogenesis of the coexistence of these lesions.
膜性肾病是成人肾病综合征的常见病因，可为原发性，也可为系统性红斑狼疮、慢性感染或药物等引起的继发性。膜性肾病患者的肾功能迅速下降可能是由于肾静脉血栓形成、恶性高血压或累及肾实质的另一种叠加破坏性过程。新月体在原发性膜性肾病中罕见，因此提示存在另一种基础疾病过程，如合并膜性和局灶性或弥漫性狼疮性肾炎。然而，在一些有新月体的膜性肾病患者中，新月体病变可能是由于一种独特的、独立的疾病过程，如抗肾小球基底膜抗体或抗中性粒细胞胞质抗体相关的寡免疫性肾小球肾炎。本文我们描述了这样一个肾脏活检结果的病例，复习了既往报道的病例，并讨论了这些病变共存对发病机制的可能影响。
