Bhasin H K, Abuelo J G, Nayak R, Esparza A R
Lab Invest. 1978 Jul;39(1):21-9.
Eleven cases of mesangial proliferative glomerulonephritis whose kidney biopsies were studied with light, immunofluorescent, and electron microscopy are described. Nine patients presented with nephrotic syndrome, one with proteinuria and hematuria, and one with proteinuria alone. Morphologically mesangial proliferative glomerulonephritis was characterized by diffuse mesangial cell proliferation and some increase in mesangial matrix. On immunofluorescence, mesangial IgM deposition was observed in all cases and was considered a distinct feature of mesangial proliferative glomerulonephritis. Electron microscopy showed electron-dense granular deposits within the mesangial matrix in four cases. The clinical course was variable. Of the eight cases with nephrotic syndrome, four treated with steroids alone and four treated with steroids and cytotoxic drugs, one in each group achieved remission while the remaining patients continued to have steroid dependency or resistance. Two of these latter patients manifested steroid responsiveness, steroid resistance, and spontaneous remission at different times in their courses. Renal function remained normal in all. These cases demonstrate that mesangial proliferative glomerulonephritis is an entity characterized by increased mesangial cellularity, deposition of IgM in a mesangial distribution, a relatively benign course, and variable response to treatment.
本文描述了11例经光镜、免疫荧光和电子显微镜检查肾脏活检的系膜增生性肾小球肾炎病例。9例患者表现为肾病综合征，1例有蛋白尿和血尿，1例仅有蛋白尿。形态学上，系膜增生性肾小球肾炎的特征是系膜细胞弥漫性增生和系膜基质有所增加。免疫荧光检查发现，所有病例均有系膜IgM沉积，这被认为是系膜增生性肾小球肾炎的一个显著特征。电子显微镜检查显示，4例患者的系膜基质内有电子致密颗粒状沉积物。临床病程各不相同。8例肾病综合征患者中，4例仅接受类固醇治疗，4例接受类固醇和细胞毒性药物治疗，每组各有1例缓解，其余患者仍有类固醇依赖或抵抗。后两组中的2例患者在病程的不同阶段表现出类固醇反应性、类固醇抵抗和自发缓解。所有患者的肾功能均保持正常。这些病例表明，系膜增生性肾小球肾炎是一种以系膜细胞增多、系膜分布的IgM沉积、相对良性的病程以及对治疗反应各异为特征的疾病。
