DE Brito T, Hoshino-Shimizu S, Neto V A, Duarte I S, Penna D O
Am J Trop Med Hyg. 1975 Jan;24(1):9-18.
Glomerular involvement characterized by mesangial cell proliferation with fibrillar thickening of the axial region and deposits of immune complexes is reported in three human cases of kala-azar. IgG was seen in all 3 and Igm in 2 patients. Complement (C3) was detected in the glomeruli in all cases and fibrinogen in the only case in which it was tested for. The deposits appeared mainly along the mesangium and their staining was particularly strong for complement and IgG. Electron microscopy detected granular electron dense deposits mainly close to mesangial cells. In one case clumps made us of electron dense lamellae were seen in the glomerular basal membrane interpreted as evidence of focal membranolysis. No granulocytes were seen in the glomeruli. Attempts to demonstrate antigen were unsuccessful. The pattern of the lesion resembles that described in the kidney of human cases of hepatosplenic schistosomiasis, and the distribution of the deposits suggests that relatively large, poorly soluble complexes formed either in the presence of excess antigen or, under certain circumstances, in the presence of excess antibody, are trapped in the glomerular capillaries. The aggregates are partially shunted to the mesangial cells, which enlarge and proliferate.
在三例黑热病患者中，报告了肾小球受累情况，其特征为系膜细胞增殖，伴有轴区纤维状增厚及免疫复合物沉积。所有3例均可见IgG，2例可见IgM。所有病例的肾小球中均检测到补体（C3），仅在1例进行检测的病例中检测到纤维蛋白原。沉积物主要出现在系膜区，其补体和IgG染色特别强烈。电子显微镜检测到颗粒状电子致密沉积物，主要靠近系膜细胞。在1例中，在肾小球基底膜中可见由电子致密薄片构成的团块，被解释为局灶性膜溶解的证据。在肾小球中未见粒细胞。证明抗原的尝试未成功。病变模式类似于人类肝脾血吸虫病病例肾脏中所描述的情况，沉积物的分布表明，在存在过量抗原或在某些情况下存在过量抗体时形成的相对较大、溶解性差的复合物被困在肾小球毛细血管中。这些聚集体部分分流至系膜细胞，导致系膜细胞增大并增殖。
