Yoshida Maria, Hirashio Shuma, Doi Toshiki, Masuda Yukinari, Shimizu Akira, Masaki Takao
Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan.
Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
Case Rep Nephrol Dial. 2021 Feb 3;11(1):36-47. doi: 10.1159/000509470. eCollection 2021 Jan-Apr.
Lupus nephritis (LN) is most frequently associated with poor outcomes in patients with systemic lupus erythematosus (SLE). LN manifests as histopathological changes in the kidney caused by immune complex formation and deposition. In particular, immunoglobulin G (IgG) deposits are frequently observed by immunofluorescence staining, which helps to establish the diagnosis of LN. In this case report, we describe a 57-year-old woman with SLE who had been undergoing treatment on an outpatient basis for 11 years. Her first and second renal biopsies revealed class V LN with a coarsely granular pattern of IgG deposition in the peripheral capillary walls. However, her third renal biopsy showed no IgG deposition, which indicated histopathological resolution of her class V LN. We used low-vacuum scanning electron microscopy (LV-SEM) to examine the three-dimensional structural alterations in her glomerular basement membranes. In this report, we describe findings that indicated resorption of epithelial deposits, that is, resolution of LN. The results of repeated kidney biopsies confirmed by LV-SEM suggested the possibility of a state unrelated to LN.
狼疮性肾炎（LN）在系统性红斑狼疮（SLE）患者中最常与不良预后相关。LN表现为免疫复合物形成和沉积导致的肾脏组织病理学改变。特别是，通过免疫荧光染色经常观察到免疫球蛋白G（IgG）沉积，这有助于确立LN的诊断。在本病例报告中，我们描述了一名57岁的SLE女性患者，她已接受门诊治疗11年。她的第一次和第二次肾活检显示为V级LN，外周毛细血管壁有粗大颗粒状的IgG沉积模式。然而，她的第三次肾活检未显示IgG沉积，这表明她的V级LN在组织病理学上得到缓解。我们使用低真空扫描电子显微镜（LV-SEM）检查了她肾小球基底膜的三维结构改变。在本报告中，我们描述了表明上皮沉积物吸收的发现，即LN的缓解。经LV-SEM证实的重复肾活检结果提示了一种与LN无关状态的可能性。
