Department of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, Japan.
Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
BMC Nephrol. 2023 May 22;24(1):139. doi: 10.1186/s12882-023-03204-3.
Extra-capillary hypercellularity is a common finding in crescentic glomerulonephritis (GN) and focal segmental glomerulosclerosis (FSGS). In diabetic nephropathy (DN), extra-capillary hypercellularity is often observed as a finding of complications such as IgA nephropathy or microscopic polyangiitis superimposed on DN. However, in rare cases, epithelial cell proliferation may accompany DN. We experienced a case of nodular diabetic glomerulosclerosis with marked extra-capillary hypercellularity and revealed the origin of this atypical lesion using immunostainings.
A man in his 50 s was admitted to the hospital with nephrotic syndrome, and a renal biopsy was performed. Diffuse nodular lesions and extra-capillary hypercellularity were observed, but the results of serological examination or immunofluorescent assays did not implicate any other crescentic GN. Immunostaining for claudin-1 and nephrin was performed to identify the origin of the extra-capillary lesions. Given the clinical course and pathological findings, a diagnosis of DN-associated extra-capillary cell proliferation was made.
Extra-capillary hypercellularity, which resembles FSGS or crescentic GN, is a rare finding in DN and should therefore be treated with caution. In such cases, co-staining for claudin-1 and nephrin may facilitate the diagnosis of DN.
细胞外细胞增生是新月体性肾小球肾炎 (GN) 和局灶节段性肾小球硬化症 (FSGS) 的常见表现。在糖尿病肾病 (DN) 中，细胞外细胞增生常作为并发症的表现，如 IgA 肾病或显微镜下多血管炎合并 DN。然而，在极少数情况下，上皮细胞增殖可能与 DN 相关。我们遇到了一例伴有明显细胞外细胞增生的结节性糖尿病肾小球硬化症病例，并通过免疫组化染色揭示了这种非典型病变的起源。
一名 50 多岁的男性因肾病综合征入院，进行了肾活检。观察到弥漫性结节性病变和细胞外细胞增生，但血清学检查或免疫荧光检测结果未提示任何其他新月体性 GN。进行 claudin-1 和 nephrin 的免疫组化染色以确定细胞外病变的起源。根据临床病程和病理发现，诊断为与 DN 相关的细胞外细胞增殖。
在 DN 中，类似于 FSGS 或新月体性 GN 的细胞外细胞增生是一种罕见表现，因此应谨慎处理。在这种情况下，claudin-1 和 nephrin 的共染色可能有助于诊断 DN。
