Hall-Craggs M, Ramos E
Nephron. 1981;28(1):42-5. doi: 10.1159/000182093.
Transformation of diffuse proliferative glomerulonephritis to membranous nephropathy 10 years later, in a patient with systemic lupus erythematosus, is reported. The original biopsy showed diffuse proliferative glomerulonephritis with epithelial crescent formation, 'wire loop' thickening of the capillary walls and moderately severe interstitial inflammation. Electron microscopy showed large subendothelial electron-dense deposits. Following treatment with a combination of prednisone and azathioprine for 2 years the 24-hour urine protein decreased from 8.8 g to 300 mg. In September, 1979, she again developed facial and pedal edema. With the exception of proteinuria of 6.0 g/24 h, the renal function remained normal. Repeat renal biopsy showed membranous glomerulopathy. On electron microscopy, electron-dense deposits were predominantly in a subepithelial position. The significance of the original biopsy as a predictor of eventual outcome and of sequential biopsies to the clinical management of patients with systemic lupus erythematosus is discussed.
报告了一例系统性红斑狼疮患者在10年后弥漫性增殖性肾小球肾炎转变为膜性肾病的情况。最初的活检显示弥漫性增殖性肾小球肾炎伴有上皮新月体形成、毛细血管壁“铁丝圈”样增厚以及中度严重的间质炎症。电子显微镜检查显示内皮下有大量电子致密沉积物。在用泼尼松和硫唑嘌呤联合治疗2年后，24小时尿蛋白从8.8克降至300毫克。1979年9月，她再次出现面部和足部水肿。除了24小时蛋白尿为6.0克外，肾功能仍正常。重复肾活检显示为膜性肾小球病。电子显微镜检查显示，电子致密沉积物主要位于上皮下位置。讨论了最初活检作为最终结局预测指标的意义以及连续活检对系统性红斑狼疮患者临床管理的意义。
