Suzuki J, Yoshikawa N, Nakamura H
Department of Pediatrics, Kobe University Hospital, Japan.
J Pathol. 1990 May;161(1):57-64. doi: 10.1002/path.1711610110.
Quantitative analysis of the mesangial matrix and cells was performed on serial renal biopsies from 41 children with IgA nephropathy. In the repeat renal biopsy, nine patients showed a significant increase of mesangial matrix, 29 showed no change and in three there was a significant decrease. Eight of the nine patients (89 per cent) with a matrix increase had persistent proteinuria at the second biopsy, whereas only 14 of the 32 (44 per cent) without a matrix increase had persistent proteinuria (P less than 0.05). Although the mesangial matrix increased in patients with persistent proteinuria, there was no decrease in patients with clinical remission. In contrast to the mesangial matrix, mesangial cells significantly decreased in 23 patients, did not change in 16, and significantly increased in only two in the second biopsy. These findings suggest that mesangial matrix increase is usually an irreversible change and that persistent proteinuria is associated with matrix increase with worsening in glomerular morphology and clinical outcome. This study indicates the importance of serial renal biopsy in children with IgA nephropathy with persistent proteinuria.
对41例IgA肾病患儿的系列肾活检组织进行了系膜基质和细胞的定量分析。在重复肾活检中，9例患者系膜基质显著增加，29例无变化，3例显著减少。系膜基质增加的9例患者中，有8例（89%）在第二次活检时存在持续性蛋白尿，而系膜基质未增加的32例患者中只有14例（44%）有持续性蛋白尿（P<0.05）。虽然持续性蛋白尿患者的系膜基质增加，但临床缓解的患者系膜基质并未减少。与系膜基质不同，23例患者的系膜细胞在第二次活检时显著减少，16例无变化，仅2例显著增加。这些发现表明，系膜基质增加通常是不可逆的变化，持续性蛋白尿与基质增加相关，伴有肾小球形态和临床结局恶化。本研究表明了系列肾活检在持续性蛋白尿的IgA肾病患儿中的重要性。
