Perez-Fontan M, Huarte E, Tellez A, Rodriguez-Carmona A, Picazo M L, Martinez-Ara J
Nephrology Service, Hospital La Paz, Madrid, Spain.
Am J Kidney Dis. 1988 Apr;11(4):298-306. doi: 10.1016/s0272-6386(88)80134-3.
Of three patients with Coxiella burnetii endocarditis, two developed focal segmental proliferative glomerulonephritis (GN), and the third developed diffuse intracapillary proliferative glomerulonephritis. In one case, a good therapeutic response was followed by partial remission of the renal alterations, but 10 months later there were clinical and histological signs of active glomerular nephropathy, suggesting that the antigenic stimulus persisted. In another case, poor evolution of the infection was accompanied by clinically and histologically aggressive glomerular nephropathy, and advanced renal failure. The third patient, who had diffuse proliferative glomerulonephritis, underwent renal biopsy earlier than the other two cases, and the behavior of the nephropathy has not been aggressive to date. Immunohistopathologic study revealed a diffuse granular deposit of IgM and C3 in all three cases; the first two also presented a discrete linear IgG deposit in the capillary loops. Attempts to identify C burnetii antigen at the glomerular level by immunohistologic techniques failed in two patients. The literature on the association of chronic Q fever with glomerulonephritis is briefly reviewed.
在三名患有伯氏考克斯体心内膜炎的患者中，两名患者出现了局灶节段性增生性肾小球肾炎（GN），第三名患者出现了弥漫性毛细血管内增生性肾小球肾炎。在一例患者中，良好的治疗反应后肾脏病变部分缓解，但10个月后出现了活动性肾小球肾病的临床和组织学迹象，提示抗原刺激持续存在。在另一例患者中，感染进展不佳伴有临床和组织学上侵袭性的肾小球肾病以及晚期肾衰竭。第三名患有弥漫性增生性肾小球肾炎的患者比其他两例患者更早接受了肾活检，迄今为止肾病的进展并不具有侵袭性。免疫组织病理学研究显示，所有三例患者均有IgM和C3的弥漫性颗粒状沉积；前两例患者在毛细血管袢中还出现了离散的线性IgG沉积。通过免疫组织学技术在肾小球水平鉴定伯氏考克斯体抗原的尝试在两名患者中失败。本文简要回顾了慢性Q热与肾小球肾炎关联的相关文献。
