Cahen R, Francois B, Trolliet P, Gilly J, Parchoux B
Division of Nephrology, Lyon-South Medical Center, Claude Bernard University, France.
Nephrol Dial Transplant. 1989;4(3):172-80. doi: 10.1093/oxfordjournals.ndt.a091852.
Eighty-two consecutive Caucasian adults (52 males, 30 females, aged 17-86 years) with membranous glomerulonephritis were prospectively evaluated for possible aetiological factors 1-4 weeks after renal biopsy. Presumed causes were identified in 17 patients (21%) as follows: drugs in five (D-penicillamine 3, captopril 1, fenoprofen 1); malignancy in four; chronic thyroiditis in three; systemic lupus erythematosus (SLE) in two; secondary syphilis in one; hepatitis B virus (HBV) infection in one and non-insulin-dependent diabetes mellitus in one patient. Except for age (patients with secondary membranous glomerulonephritis were older), clinical presentation and histological stage distribution did not differ between the secondary and the primary groups. Ten out of the 17 patients with secondary membranous glomerulonephritis (59%) achieved complete clinical remission within 12 months. The incidence of associated conditions in adults with membranous glomerulonephritis in this study corresponds with that reported in the few previous series. Although membranous glomerulonephritis is deemed to be idiopathic in most cases, it seems warranted to search for medication, malignancy, SLE, HBV infection, syphilis and thyroiditis as possible aetiological factors. Further evaluation should be orientated by the clinical context. An improved outcome of membranous glomerulonephritis may be expected insofar as the underlying condition is controlled.
82例连续性高加索成年膜性肾小球肾炎患者（52例男性，30例女性，年龄17 - 86岁）在肾活检后1 - 4周对可能的病因进行前瞻性评估。17例患者（21%）确定了推测病因，如下：药物所致5例（青霉胺3例、卡托普利1例、非诺洛芬1例）；恶性肿瘤4例；慢性甲状腺炎3例；系统性红斑狼疮（SLE）2例；二期梅毒1例；乙型肝炎病毒（HBV）感染1例和非胰岛素依赖型糖尿病1例。除年龄外（继发性膜性肾小球肾炎患者年龄较大），继发性和原发性组的临床表现和组织学分期分布无差异。17例继发性膜性肾小球肾炎患者中有10例（59%）在12个月内实现完全临床缓解。本研究中成年膜性肾小球肾炎患者相关疾病的发生率与之前少数系列报道相符。虽然在大多数情况下膜性肾小球肾炎被认为是特发性的，但寻找药物、恶性肿瘤、SLE、HBV感染、梅毒和甲状腺炎作为可能的病因似乎是有必要的。进一步评估应以临床情况为导向。只要基础疾病得到控制，膜性肾小球肾炎可能会有更好的预后。
