Tateno S, Kobayashi Y, Shigematsu H, Hiki Y
Q J Med. 1983 Summer;52(207):311-31.
This study describes the clinical and pathological characteristics of 74 patients with lupus nephritis classified according to renal biopsy findings using light, electron and immunofluorescent microscopy, and further, assesses the significance of subendothelial deposits in evaluating disease activity. In membranous lupus nephritis (14 cases), many cases showed normal renal function even with the nephrotic syndrome, although five cases had little or no urinary abnormalities. Glomerular cellular proliferation was very mild and subepithelial deposits with a few mesangial deposits were the main pathological alterations. Mesangial proliferative lupus nephritis (17 cases) clinically had very mild renal disease. Renal biopsies in this group revealed mesangial deposits with slight cellular proliferation. Although clinical features of mild diffuse proliferative lupus nephritis (16 cases) were similar to those of mesangial lupus nephritis, glomerular loop deposits were seen in addition to mesangial deposits. In moderate diffuse proliferative lupus nephritis (17 cases), renal function was slightly decreased, moderate proteinuria with haematuria were found, and C3 level was low. Renal biopsies showed active proliferative changes, and subendothelial deposits were frequently seen. In severe diffuse proliferative lupus nephritis (10 cases), the duration from onset of SLE to renal biopsy was short. Impairment of renal function, and nephrotic syndrome with haematuria and hypocomplementemia were frequent. Only three patients survived in this group. Renal biopsies demonstrated highly active proliferative and necrotizing changes, and electron microscopy showed massive subendothelial and mesangial deposits accompanied by subepithelial and intramembranous deposits. The amount of subendothelial deposits correlated with those of mesangial deposits and subepithelial deposits in the cases with diffuse proliferative lupus nephritis. Urinary protein loss and histologic activity showed statistically significant correlations with the amount of subendothelial deposits, but C3 levels and creatinine clearance revealed negative correlations with those deposits.
本研究描述了74例狼疮性肾炎患者的临床和病理特征，这些患者根据肾活检结果，采用光镜、电镜和免疫荧光显微镜进行分类，此外，还评估了内皮下沉积物在评估疾病活动中的意义。在膜性狼疮性肾炎（14例）中，许多病例即使患有肾病综合征，肾功能仍正常，尽管有5例几乎没有或没有尿液异常。肾小球细胞增殖非常轻微，上皮下沉积物伴有少量系膜沉积物是主要的病理改变。系膜增生性狼疮性肾炎（17例）临床上肾病非常轻微。该组肾活检显示系膜沉积物伴有轻微细胞增殖。虽然轻度弥漫性增生性狼疮性肾炎（16例）的临床特征与系膜性狼疮性肾炎相似，但除系膜沉积物外，还可见肾小球袢沉积物。在中度弥漫性增生性狼疮性肾炎（17例）中，肾功能略有下降，发现中度蛋白尿伴血尿，C3水平较低。肾活检显示有活跃的增殖性改变，且经常可见内皮下沉积物。在重度弥漫性增生性狼疮性肾炎（10例）中，从系统性红斑狼疮发病到肾活检的时间较短。肾功能损害、伴有血尿和低补体血症的肾病综合征很常见。该组仅3例患者存活。肾活检显示高度活跃的增殖性和坏死性改变，电镜显示大量内皮下和系膜沉积物，伴有上皮下和膜内沉积物。在弥漫性增生性狼疮性肾炎病例中，内皮下沉积物的数量与系膜沉积物和上皮下沉积物的数量相关。尿蛋白丢失和组织学活性与内皮下沉积物的数量呈统计学显著相关，但C3水平和肌酐清除率与这些沉积物呈负相关。
