Cavallo T, Cameron W R, Lapenas D
Am J Pathol. 1977 Apr;87(1):1-18.
Detailed immunopathologic studies of early or silent renal alterations in systemic lupus erythematosus have been sparse. The renal biopsies of 16 lupus patients with normal renal function, including 8 with hematuria and/or proteinuria of recent onset, and 8 without clinically detectable renal disease were investigated by light, immunofluorescence, and electron microscopy. Immunoglobulins, complement components, and electron-dense deposits were detected in glomeruli of all patients, regardless of morphologic appearance or lack of clinical evidence of renal involvement. Features of membranous glomerulonepritis were observed in 4 patients with substantial proteinuria. In the remaining 12 patients, including 3 with hematuria and 4 with slight proteinuria, either minimal glomerular alterations or features of mesangial proliferative glomerulonephritis were seen. Transformation of the original disease was demonstrated in 3 of 3 patients rebiopsied within 2 years. The significance of these findings is discussed in relation to a) the spectrum of clinical and immunopathologic alterations in lupus nephritis and b) transformation of the original disease.
系统性红斑狼疮早期或隐匿性肾脏改变的详细免疫病理学研究一直较少。对16例肾功能正常的狼疮患者进行了肾活检，其中8例近期出现血尿和/或蛋白尿，8例无临床可检测到的肾脏疾病，通过光镜、免疫荧光和电子显微镜进行研究。无论形态学表现或有无肾脏受累的临床证据，所有患者的肾小球均检测到免疫球蛋白、补体成分和电子致密沉积物。4例大量蛋白尿患者观察到膜性肾小球肾炎的特征。其余12例患者，包括3例血尿患者和4例轻度蛋白尿患者，可见轻度肾小球改变或系膜增生性肾小球肾炎的特征。在2年内再次活检的3例患者中，有3例证实了原发病的转变。结合以下方面讨论了这些发现的意义：a）狼疮性肾炎的临床和免疫病理学改变谱；b）原发病的转变。
