Huang Yan-Mei, Zhou Hui-Rong, Zhang Ling, Yang Ke-Ke, Luo Jiang-Xi, Zhao Hai-Lu
aCenter for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin bDepartment of Surgical Pathology, KingMed Diagnostics, Guangzhou, China. cNingbo Yongjiang Advanced Vocational High School, Ningbo, 305010 dDepartment of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, Nantong, 226001.
Medicine (Baltimore). 2016 Jun;95(26):e4022. doi: 10.1097/MD.0000000000004022.
Membranous glomerulonephritis (MGN) represents an immunologically mediated disease characterized by deposition of immune complexes in the glomerular subepithelial space. Persistent proteinuria at diagnosis predicts poor prognosis. Pregnancy with MGN is a risk of fetal loss and may worsen maternal renal function.Here, we report a lady with MGN and proteinuria achieved spontaneous remission and successful fetal outcome naive to any medications. The 26-year old woman had 1-year history of persistent proteinuria (5.5-12.56 g/24 hours) and biopsy-proven MGN. Histopathological characteristics included glomerular basement membrane spikes, subepithelial monoclonal IgG immunofluorescence, and diffuse electron dense deposits. She was sticking to a regular morning exercise routine without any medications. After successful delivery of a full-term baby girl, the mother had improved proteinuria (0.56 g/24 hours) and albuminuria (351.96 g/24 hours contrasting 2281.6 g/24 hours before pregnancy). The baby had normal height and body weight at 4 months old.We identified more pregnancies with MGN in 5 case reports and 5 clinical series review articles (7-33 cases included). Spontaneous remission of maternal MGN with good fetal outcome rarely occurred in mothers on immunosuppressive therapy.Mothers naive to immunosuppressive therapy may achieve spontaneous remission of maternal membranous glomerulonephritis and successful fetal outcome. Theoretically, fetus might donate stem cells to heal mother's kidney.
膜性肾小球肾炎（MGN）是一种免疫介导性疾病，其特征是免疫复合物沉积于肾小球上皮下间隙。诊断时持续性蛋白尿预示预后不良。MGN患者怀孕有胎儿丢失风险，且可能使母体肾功能恶化。在此，我们报告一位患有MGN和蛋白尿的女性，未经任何药物治疗而实现了自发缓解并获得了成功的胎儿结局。这位26岁女性有1年持续性蛋白尿病史（5.5 - 12.56克/24小时），肾活检证实为MGN。组织病理学特征包括肾小球基底膜钉突、上皮下单克隆IgG免疫荧光以及弥漫性电子致密沉积物。她坚持日常晨练，未服用任何药物。成功分娩一名足月女婴后，母亲的蛋白尿（0.56克/24小时）和白蛋白尿（351.96克/24小时，与妊娠前的2281.6克/24小时形成对比）有所改善。婴儿4个月大时身高和体重正常。我们在5篇病例报告和5篇临床系列综述文章（共纳入7 - 33例病例）中发现了更多MGN患者怀孕的情况。接受免疫抑制治疗的母亲中，母体MGN自发缓解且胎儿结局良好的情况很少见。未接受免疫抑制治疗的母亲可能实现母体膜性肾小球肾炎的自发缓解和成功的胎儿结局。从理论上讲，胎儿可能捐赠干细胞来治愈母亲的肾脏。
