Barbiano di Belgiojoso G, Bertoli S, Tarantino A, Colasanti G, Bosisio-Bestetti M, Ferrario F, Montagnino G, Banfi G, Bucci A, Surian M, Colussi G, Guerra L, Micoli G
Boll Ist Sieroter Milan. 1981;60(4):316-27.
56 renal biopsies in 48 patients affected by essential mixed IgG-IgM cryoglobulinemia have been examined by light microscopy and immunofluorescence. Patients were classified in four groups: 1) minimal lesions (4 patients); 2) pure proliferative mesangial lesions (9 patients); 3) membranoproliferative glomerulonephritis (23 patients); 4)proliferative glomerulonephritis with prominent intraluminal thrombi (12 patients). In this last group large intraluminal thrombi intensely fixing anti-IgG and IgM antisera were present; unlike the preceding groups, few deposits on capillary walls were seen. These four groups differed in renal clinical syndrome at presentation: in particular, proteinuria or nephrotic syndrome was the predominant manifestation in group 3, acute nephritic syndrome in group 4. In the latter, reversal of renal failure and regression of lesions could be observed. Various morphological aspects tend to show that in this disease more than one mechanism is operating in producing renal damage, including local trapping of abnormal circulating proteins.
对48例患有原发性混合性IgG-IgM冷球蛋白血症患者的56份肾活检标本进行了光学显微镜和免疫荧光检查。患者被分为四组：1）轻微病变（4例患者）；2）单纯增生性系膜病变（9例患者）；3）膜增生性肾小球肾炎（23例患者）；4）伴有显著管腔内血栓形成的增生性肾小球肾炎（12例患者）。在最后一组中，存在大量强烈结合抗IgG和IgM抗血清的管腔内血栓；与前几组不同，在毛细血管壁上可见的沉积物很少。这四组在初诊时的肾脏临床综合征有所不同：特别是，蛋白尿或肾病综合征是第3组的主要表现，急性肾炎综合征是第4组的主要表现。在后者中，可以观察到肾衰竭的逆转和病变的消退。各种形态学方面倾向于表明，在这种疾病中，不止一种机制在导致肾损伤，包括异常循环蛋白的局部截留。
