Mandal A K, Nordquist J A, Kraikitpanitch S, Lindeman R D
Am J Med Sci. 1977 Nov-Dec;274(3):317-23. doi: 10.1097/00000441-197711000-00011.
Renal tissues were studied using electron microscopy (EM) and immunofluorescence microscopy (IFM) from three patients who were found to have chronic interstitial nephritis (pyelonephritis) by light microscopy (LM). By LM, 90% of the glomeruli in two patients and all glomeruli in one patient were normal. By EM, glomerular capillaries in all patients revealed generalized fusion of epithelial foot processes. In two patients, IFM for immunoglobulins, third component of complement and fibrinogen were negative. These two patients received corticosteroids for 6 to 12 weeks. In one, proteinuria markedly decreased (from 17.9 to 1.1 gm) in four weeks and in the other follow-up studies of renal histology revealed normal glomeruli and partial restoration of foot processes by LM and EM respectively. Thus, this study offers evidence for lipoid nephrosis (or minimal lesion disease) as an etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). The impaired renal function in these patients is attributed to tubulo-interstitial disease rather than glomerular pathology. It remains to be determined whether the two disparate pathological conditions have coexisted or chronic interstitial nephritis had led to the appearance of lipoid nephrosis through an unidentified mechanism.
对三名经光学显微镜（LM）检查发现患有慢性间质性肾炎（肾盂肾炎）的患者的肾组织进行了电子显微镜（EM）和免疫荧光显微镜（IFM）研究。通过LM检查，两名患者90%的肾小球及一名患者的所有肾小球均正常。通过EM检查，所有患者的肾小球毛细血管均显示上皮足突广泛融合。两名患者的免疫球蛋白、补体第三成分和纤维蛋白原的IFM检查均为阴性。这两名患者接受了6至12周的皮质类固醇治疗。其中一名患者在四周内蛋白尿明显减少（从17.9克降至1.1克），另一名患者的肾脏组织学随访研究分别通过LM和EM显示肾小球正常且足突部分恢复。因此，本研究为脂性肾病（或微小病变病）作为慢性间质性肾炎（肾盂肾炎）中肾病综合征的病因提供了证据。这些患者的肾功能损害归因于肾小管间质疾病而非肾小球病变。这两种不同的病理状况是并存，还是慢性间质性肾炎通过一种未知机制导致了脂性肾病的出现，仍有待确定。
