[一例结节病合并膜性肾病]

[A case of sarcoidosis associated with membranous nephropathy].

作者信息

Yamada A, Kojima H, Watanabe S, Itou T, Tanuma Y, Seki M, Ohi H, Hatano M, Furuta K, Yamamoto M

出版信息

Nihon Jinzo Gakkai Shi. 1989 Jan;31(1):25-9.

Abstract

A 59-year-old woman was admitted to the hospital with a complaint of right visual disturbance. At admission, she had proteinuria and microscopic hematuria. The pulmonary X-ray showed bilateral hilar lymphadenopathy (BHL) but tuberculin test were negative. Also, bronchoalveolar lavage (BAL) and renal biopsy were performed. Bronchoalveolar lavage fluid (BALF) contained a high percentage of OKT 4 positive cells. In renal biopsy, light microscopic study showed thickening glomerular basement membrane (GBM) with tubulo-interstitial legion. Immuno-fluorescent study revealed granular deposits of IgG along glomerular capillary wall. Electron microscopic study showed subepithelial electron dense deposits of GBM, which are characteristic for membranous nephropathy (MN). It is well known that both sarcoidosis and MN are associated with immunological abnormality. This case might be significant for the study of pathogenesis of sarcoidosis.

摘要

一名59岁女性因右侧视力障碍入院。入院时，她有蛋白尿和镜下血尿。肺部X线显示双侧肺门淋巴结肿大（BHL），但结核菌素试验为阴性。此外，还进行了支气管肺泡灌洗（BAL）和肾活检。支气管肺泡灌洗液（BALF）中OKT 4阳性细胞比例较高。肾活检中，光镜检查显示肾小球基底膜（GBM）增厚伴肾小管间质病变。免疫荧光研究显示IgG沿肾小球毛细血管壁呈颗粒状沉积。电镜研究显示GBM上皮下电子致密沉积物，这是膜性肾病（MN）的特征。众所周知，结节病和MN都与免疫异常有关。该病例可能对结节病发病机制的研究具有重要意义。