Slater D N, Hague W M
Histopathology. 1984 Jul;8(4):567-81. doi: 10.1111/j.1365-2559.1984.tb02369.x.
Renal morphological changes are described in four cases of idiopathic acute fatty liver of pregnancy. Light microscopy showed mild glomerular hypercellularity together with thickening and narrowing of capillary loops. In two cases the tubules showed lipid accumulation which included free fatty acids. Electron microscopy showed mesangial cell interposition between the basal lamina and endothelial cells. Glomeruli contained electron dense material in a subendothelial location. Immunoperoxidase stains showed diffuse segmental deposits of fibrin/fibrinogen and IgM in relation to glomerular capillary loops. IgG and C3 were found in three and two cases respectively. Pathogenetic mechanisms including disseminated intravascular coagulation, immune complex deposition and alterations in lipid metabolism are discussed. Coexistent preeclampsia is considered to be an unlikely explanation for the changes. There is a possibility that these renal changes comprise an early feature of idiopathic acute fatty liver of pregnancy.
本文描述了4例妊娠特发性急性脂肪肝患者的肾脏形态学变化。光镜检查显示肾小球轻度细胞增多，伴有毛细血管袢增厚和狭窄。2例肾小管出现脂质蓄积，其中包括游离脂肪酸。电镜检查显示系膜细胞插入基膜和内皮细胞之间。肾小球内皮细胞下有电子致密物质。免疫过氧化物酶染色显示，与肾小球毛细血管袢相关的纤维蛋白/纤维蛋白原和IgM呈弥漫性节段性沉积。分别在3例和2例中发现了IgG和C3。文中讨论了包括弥散性血管内凝血、免疫复合物沉积和脂质代谢改变在内的发病机制。同时存在的先兆子痫不太可能是这些变化的原因。这些肾脏变化有可能是妊娠特发性急性脂肪肝的早期特征。
