Tsumagari T, Fukumoto S, Kinjo M, Tanaka K
Hum Pathol. 1985 Jan;16(1):43-9. doi: 10.1016/s0046-8177(85)80212-4.
A clinicopathologic autopsy study of the vascular changes in the kidneys of 100 patients with systemic lupus erythematosus was undertaken. Necrotizing arteritis was found in seven patients, mucinous intimal thickening in nine, onion-skin intimal thickening in two, and renal vein thrombosis in two. Active necrotizing arteritis was present most frequently in the arterioles and interlobular arteries, with healing necrotizing arteritis predominating in the arcuate and interlobar arteries. These events were closely related to the activity of glomerular lesions, and immunologic vascular injury seemed to be the causative factor. Rapidly progressive renal failure and severe hypertension had characterized the clinical courses of the patients. Mucinous intimal thickening, present in the arterioles and interlobular arteries, had been accompanied by accelerated hypertension. Although dialysis or accelerated hypertension may have been causes, other factors, including glucocorticoid therapy, must be considered. In one patient with class II lupus nephritis, renal vein thrombosis was considered the cause of the nephrotic syndrome. These vasculopathies, often detected in patients with lupus at autopsy, seem to alter the clinical course.
对100例系统性红斑狼疮患者肾脏血管变化进行了临床病理尸检研究。发现7例患者有坏死性动脉炎，9例有黏液性内膜增厚，2例有洋葱皮样内膜增厚，2例有肾静脉血栓形成。活动性坏死性动脉炎最常见于小动脉和小叶间动脉，愈合性坏死性动脉炎在弓形动脉和叶间动脉中占主导。这些病变与肾小球病变的活动密切相关，免疫性血管损伤似乎是致病因素。快速进行性肾衰竭和严重高血压是这些患者临床病程的特征。存在于小动脉和小叶间动脉的黏液性内膜增厚伴有高血压加速。虽然透析或高血压加速可能是原因，但必须考虑其他因素，包括糖皮质激素治疗。在1例Ⅱ级狼疮性肾炎患者中，肾静脉血栓形成被认为是肾病综合征的原因。这些血管病变在狼疮患者尸检时经常被发现，似乎会改变临床病程。
