Falck H M, Törnroth T, Skrifvars B, Wegelius O
Acta Med Scand. 1979;205(7):651-6. doi: 10.1111/j.0954-6820.1979.tb06121.x.
A patient with seronegative rheumatoid arthritis developed a nephrotic syndrome. Histological examination of renal biopsy disclosed moderate amyloidosis. Ultrastructurally the glomerular amyloid deposits were seen to be located both within the mesangium and subepithelially in the peripheral capillaries. The patient was treated with prednisone and cyclophosphamide for two years. The nephrotic syndrome remitted and a follow-up biopsy showed almost total disappearance of Congo red positive amyloid substance. Electron microscopy showed abundant finely granular material but only small amounts of fibrillar amyloid in the mesangial regions and intramembranous lucent areas containing few amyloid fibrils but no subepithelial deposits in the peripheral capillaries. We conclude that the mesangial amyloid substance was degraded to granular material and that the subepithelial amyloid deposits were resolved by mechanisms similar to those involved in the resolution of subepithelial immune complex deposits, i.e. through slow washing out and incorporation into the basement membrane.
一名血清阴性类风湿关节炎患者出现了肾病综合征。肾活检组织学检查显示中度淀粉样变性。超微结构观察发现肾小球淀粉样沉积物位于系膜区和外周毛细血管的上皮下。该患者接受泼尼松和环磷酰胺治疗两年。肾病综合征缓解，随访活检显示刚果红阳性淀粉样物质几乎完全消失。电子显微镜检查显示系膜区有大量细颗粒物质，但仅有少量纤维状淀粉样物质，外周毛细血管的膜内透亮区含少量淀粉样纤维，无上皮下沉积物。我们得出结论，系膜淀粉样物质降解为颗粒物质，上皮下淀粉样沉积物通过与上皮下免疫复合物沉积物溶解机制相似的方式得以清除，即通过缓慢洗脱并整合到基底膜中。
