Date A, Raghavan R, John T J, Richard J, Kirubakaran M G, Shastry J C
Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Q J Med. 1987 Sep;64(245):729-37.
Nephrotic syndrome was the commonest clinical presentation among 2827 consecutive adult Indian patients from whom adequate kidney biopsies were obtained for suspected renal disease. In 83 per cent of cases the nephrotic syndrome was due to minimal change disease, focal segmental glomerulosclerosis, mesangiocapillary glomerulonephritis, membranous usually secondary to tuberculosis or leprosy, was present in only 34 patients. Acute nephritis, the next most frequent clinical presentation, was due to diffuse endocapillary proliferative, crescentic or mesangial proliferative glomerulonephritis in 88 per cent of cases, almost half of whom had elevated serum streptococcal antibody titres. Eosinophilia showed a highly significant association with diffuse endocapillary proliferative and mesangiocapillary glomerulonephritis. Idiopathic IgA nephropathy was present in only 10, and antiglomerular basement membrane antibody disease in only one, of the 238 patients whose biopsies were studied by immunofluorescence. Complications of pregnancy accounted for 70 per cent of cases of cortical necrosis. Acute gastroenteritis, septicaemia, abortions, snake bite and allopathic and indigenous medicines were important causes of acute tubular necrosis.
在2827例因疑似肾脏疾病而接受了充分肾活检的成年印度患者中，肾病综合征是最常见的临床表现。在83%的病例中，肾病综合征是由微小病变病、局灶节段性肾小球硬化、系膜毛细血管性肾小球肾炎、膜性肾病（通常继发于结核病或麻风病）引起的，仅有34例患者存在这种情况。急性肾炎是第二常见的临床表现，88%的病例是由弥漫性毛细血管内增生性、新月体性或系膜增生性肾小球肾炎引起的，其中近一半患者的血清链球菌抗体滴度升高。嗜酸性粒细胞增多与弥漫性毛细血管内增生性和系膜毛细血管性肾小球肾炎有高度显著的相关性。在238例经免疫荧光研究活检的患者中，仅10例患有特发性IgA肾病，仅1例患有抗肾小球基底膜抗体病。妊娠并发症占皮质坏死病例的70%。急性胃肠炎、败血症、流产、蛇咬伤以及西药和本土药物是急性肾小管坏死的重要原因。
