一例罕见的成人弥漫性节段性膜性肾小球肾炎病例
A Rare Adult Case with Diffuse Segmental Membranous Glomerulonephritis.
作者信息
Fujigaki Yoshihide, Tamura Yoshifuru, Shibata Shigeru, Kondo Fukuo, Iwakura Takamasa, Kojima Kenichiro, Yamaguchi Yutaka, Uchida Shunya
机构信息
Department of Internal Medicine, Teikyo University School of Medicine, Japan.
Central Laboratory, Teikyo University School of Medicine, Japan.
出版信息
Intern Med. 2017;56(13):1691-1695. doi: 10.2169/internalmedicine.56.8298. Epub 2017 Jul 1.
A 71-year-old man with hypertension and diabetes mellitus presented with proteinuria. Laboratory data showed proteinuria of 3.1 g/g creatinine, serum albumin of 3.5 g/dL and serum creatinine of 1.03 mg/dL without autoantibodies. A renal biopsy revealed segmental granular IgG depositions on glomerular capillary walls. Electron microscopy showed segmentally subepithelial, intramembranous and mesangial deposits. Diffuse segmental membranous glomerulonephritis (MGN) was diagnosed with only IgG1 deposition and without M-type phospholipase A2 receptor or thrombospondin type-1 domain-containing 7A staining, suggesting secondary MGN with an unknown target antigen in immune deposits. Physicians should keep in mind the existence of segmental MGN to better understand the clinicopathological characteristics.
一名患有高血压和糖尿病的71岁男性出现蛋白尿。实验室检查数据显示，肌酐清除率为3.1 g/g，血清白蛋白为3.5 g/dL，血清肌酐为1.03 mg/dL，未检测到自身抗体。肾活检显示肾小球毛细血管壁有节段性颗粒状IgG沉积。电子显微镜检查显示节段性上皮下、膜内和系膜沉积。诊断为弥漫性节段性膜性肾小球肾炎（MGN），仅存在IgG1沉积，无M型磷脂酶A2受体或含血小板反应蛋白1型结构域7A染色，提示免疫沉积物中存在未知靶抗原的继发性MGN。医生应牢记节段性MGN的存在，以便更好地了解临床病理特征。
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