Tubbs R R, Gephardt G N, Calabrese L, McMahon J T, Hall P M, Valenzuela R
Arch Pathol Lab Med. 1981 Sep;105(9):474-7.
A 58-year-old woman suffering from epistasis was found to be hypertensive. Hypocomplementemia associated with normal serum creatinine level, erythrocytosis, microscopic hematuria, proteinuria, and normal serum immunoglobulin levels and immunoelectrophoresis results led to a renal biopsy. Light microscopy disclosed mesangial hypercellularity and accumulation of eosinophilic material in capillary loops and in the mesangium. Immunomicroscopy disclosed coarsely granular to globular deposition of IgG, IgM, and C3 in similar distribution. Electron microscopy demonstrated electron-dense mesangial and subendothelial deposits consisting of interlacing fibrillar bundles associated with infiltration of acute inflammatory cells characteristic of cryoglobulinemic glomerulonephritis. After the biopsy, the presence of circulating IgG-IgM cryoglobulins was documented. Substructure of the in vitro cryoprecipitate and the immune complexes in the kidney was very similar. These observations illustrate the importance of continued routine ultrastructural assessment in evaluation of renal biopsy material.
一名患有鼻出血的58岁女性被发现患有高血压。低补体血症伴有正常血清肌酐水平、红细胞增多症、镜下血尿、蛋白尿，以及正常血清免疫球蛋白水平和免疫电泳结果，遂进行了肾活检。光镜检查显示系膜细胞增多，嗜酸性物质在毛细血管袢和系膜中积聚。免疫显微镜检查显示IgG、IgM和C3呈粗颗粒状至球状沉积，分布相似。电子显微镜显示电子致密的系膜和内皮下沉积物，由交织的纤维束组成，伴有冷球蛋白血症性肾小球肾炎特征性的急性炎症细胞浸润。活检后，记录到循环中存在IgG-IgM冷球蛋白。体外冷沉淀物和肾脏中的免疫复合物的亚结构非常相似。这些观察结果说明了在评估肾活检材料时持续进行常规超微结构评估的重要性。
