McLean R H, Geiger H, Burke B, Simmons R, Najarian J, Vernier R L, Michael A F
Am J Med. 1976 Jan;60(1):60-72. doi: 10.1016/0002-9343(76)90534-9.
Sixteen patients with membranoproliferative glomerulonephritis who required kidney transplantation because of renal failure were evaluated for evidence of recurrence of the original disease by serologic and morphologic studies. Of the 12 patients with transplant tissue available for study, seven showed membranoproliferative glomerulonephritis by light morphology. Four of these seven also had hypocomplementemia, and this hypocomplementemia was characterized by decreased serum CH50, C3 beta1A or C3-C9 but norma serum C1, C4 and C2 by hemolytic assay. Immunofluorescent microscopy demonstrated more intense glomerular deposition of C3 and properdin in the hypocomplementemic patients. Ultrastructural studies demonstrated intramembranous deposits typical of dense deposit disease in one patient who also had marked hypocomplementemia. One patient who had two transplant biopsies and persistent hypocomplementemia showed progression from predominantly mesangial glomerular changes to both capillary wall and mesangial abnormalities. This study has shown a high rate of recurrence of membranoproliferative glomerulonephritis in the transplanted kidneys. A high death rate was noted in persistently hypocomplementemic patients. The serum C profile in hypcomplementemic patients who received translants was similar to that seen before transplantation, but the signficance of this finding remains unknown.
对16例因肾衰竭而需要进行肾移植的膜增生性肾小球肾炎患者，通过血清学和形态学研究评估其原发病复发的证据。在12例有移植组织可供研究的患者中，7例经光镜检查显示为膜增生性肾小球肾炎。这7例患者中有4例还存在低补体血症，通过溶血试验检测，这种低补体血症的特征是血清CH50、C3β1A或C3 - C9降低，但血清C1、C4和C2正常。免疫荧光显微镜检查显示，低补体血症患者肾小球内C3和备解素的沉积更为强烈。超微结构研究显示，1例同时有明显低补体血症的患者存在典型的致密物沉积病的膜内沉积物。1例接受了两次移植肾活检且持续存在低补体血症的患者，显示出从主要的系膜性肾小球改变进展为毛细血管壁和系膜均出现异常。本研究表明，膜增生性肾小球肾炎在移植肾中的复发率很高。持续低补体血症的患者死亡率较高。接受移植的低补体血症患者的血清补体谱与移植前相似，但这一发现的意义尚不清楚。
