Mackensen-Haen S, Eissele R, Bohle A
Institute for Pathology, University of Tuebingen, Federal Republic of Germany.
Lab Invest. 1988 Aug;59(2):239-44.
The following findings were obtained in a comparative morphometric and clinical study of 130 adult men and women with immunologically confirmed IgA nephritis: (a) IgA nephritis develops in varying frequency as minimal proliferating intercapillary glomerulonephritis, low-grade mesangioproliferative glomerulonephritis, moderate to severe mesangioproliferative glomerulonephritis, or variously severe mesangioproliferative glomerulonephritis with signs of focal accentuation. (b) Tubular epithelial surface area and interstitial width in 62 of 130 cases of IgA nephritis was the same as in normal kidneys. IgA nephritis was complicated in 33 cases by interstitial cortical fibrosis, in 23 cases by acute renal failure, and in 12 cases by acute renal failure and interstitial fibrosis. (c) In IgA nephritis with acute renal failure, the tubular epithelium (only proximal tubular epithelium was measured) was significantly swollen. In IgA nephritis with interstitial fibrosis, the epithelial surface area of the proximal tubules was significantly smaller than the normal surface area. In IgA nephritis with acute renal failure (ARF) and interstitial fibrosis, tubular swelling was less severe than in ARF. Proximal tubular epithelial surface area, however, was significantly larger than the normal surface area. (d) In IgA nephritis, like in other inflammatory and noninflammatory glomerular diseases, a significant positive correlation existed between width of the cortical interstitium and height of serum creatinine level. Moreover, in IgA nephritis, significantly negative correlation existed between width of the cortical interstitium and C creatinine. (e) In IgA nephritis, significant negative correlations existed between C creatinine and age. (f) In IgA nephritis, a significant correlation existed between proximal tubular epithelial surface area and serum creatinine level and a significant negative correlation, between C creatinine and proximal tubular epithelial surface area, when ARF cases were excluded from the total group of IgA nephritis. (All correlations are closer when the cases with accompanying ARF are eliminated.) The discrepancy between the findings of Bennett et al. (Bennett WM, Walker RG, Kincaid-Smith P: Lab Invest 47:330, 1982) and ours is clarified when it is presumed that the group of patients investigated by Bennett et al. (N = 85) included just as many ARF cases as our material. Consequently, there is no reason to correct our interpretation of the influence of tubulointerstitial changes on glomerular function.
在一项对130名经免疫学确诊为IgA肾病的成年男性和女性进行的比较形态学和临床研究中，获得了以下结果：(a) IgA肾病以不同频率发展为轻微增殖性毛细血管间肾小球肾炎、轻度系膜增生性肾小球肾炎、中度至重度系膜增生性肾小球肾炎或伴有局灶性加重体征的各种重度系膜增生性肾小球肾炎。(b) 130例IgA肾病患者中有62例的肾小管上皮表面积和间质宽度与正常肾脏相同。33例IgA肾病并发皮质间质纤维化，23例并发急性肾衰竭，12例并发急性肾衰竭和间质纤维化。(c) 在伴有急性肾衰竭的IgA肾病中，肾小管上皮（仅测量近端肾小管上皮）明显肿胀。在伴有间质纤维化的IgA肾病中，近端肾小管的上皮表面积明显小于正常表面积。在伴有急性肾衰竭（ARF）和间质纤维化的IgA肾病中，肾小管肿胀程度低于急性肾衰竭患者。然而，近端肾小管上皮表面积明显大于正常表面积。(d) 在IgA肾病中，与其他炎症性和非炎症性肾小球疾病一样，皮质间质宽度与血清肌酐水平高度之间存在显著正相关。此外，在IgA肾病中，皮质间质宽度与肌酐清除率之间存在显著负相关。(e) 在IgA肾病中，肌酐清除率与年龄之间存在显著负相关。(f) 在IgA肾病中，当将急性肾衰竭病例排除在IgA肾病总病例组之外时，近端肾小管上皮表面积与血清肌酐水平之间存在显著正相关，而肌酐清除率与近端肾小管上皮表面积之间存在显著负相关。（当排除伴有急性肾衰竭的病例时，所有相关性更紧密。）当假定Bennett等人（Bennett WM, Walker RG, Kincaid-Smith P: Lab Invest 47:330, 1982）研究的患者组（N = 85）中急性肾衰竭病例数量与我们的材料中一样多时，就澄清了Bennett等人的研究结果与我们的研究结果之间的差异。因此，没有理由纠正我们对肾小管间质变化对肾小球功能影响的解释。
