Ishihara S, Inaba S, Okada T
Department of Pediatrics, Toyama Medical and Pharmaceutical University, Japan.
Nihon Jinzo Gakkai Shi. 1994 Oct;36(10):1123-9.
We studied the contributions of glomerular hypertrophy in renal disease. The patients were 20 cases of IgA nephropathy with prolonged proteinuria, 13 cases of Alport syndrome and 12 cases of focal glomerular sclerosis (FGS). All patients had a normal creatinine level on renal biopsy. We determined the mean glomerular tuft area in the equatorial region of five glomeruli that showed no sclerotic change in each patient using an image analyzer and compared the value with the mean value in normal controls. Glomerular hypertrophy was defined as a value over the mean glomerular tuft area +1SD of normal controls. Glomerular hypertrophy was found in 14 IgA nephropathy cases (70.0%), 4 Alport syndrome cases (30.7%) and 8 FGS cases (66.7%). The incidence of glomerular hypertrophy was significantly higher in IgA nephropathy than in Alport syndrome and FGS showed a higher tendency compared with Alport syndrome. Of the patients with renal insufficiency, 4 of 6 IgA nephropathy cases (66.6%), 0 of 5 Alport syndrome cases (0%) and 1 of 3 FGS cases (33.3%) showed glomerular hypertrophy, IgA nephropathy patients showed the highest incidence of glomerular hypertrophy. The interval between the final biopsy and renal insufficiency showed no significant difference in this study. In IgA nephropathy, obsolescent glomeruli were significantly increased in the group in which the glomerular tuft area was over the mean +2SD compared with the group with an area less than the mean +2SD. FGS cases showed no relationship between the ratio of obsolescent glomeruli to whole glomeruli and glomerular hypertrophy. This study suggested that glomerular hypertrophy may cause declining renal function in IgA nephropathy, but not in Alport syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了肾小球肥大在肾脏疾病中的作用。患者包括20例持续性蛋白尿的IgA肾病、13例Alport综合征和12例局灶性肾小球硬化症（FGS）。所有患者肾活检时肌酐水平均正常。我们使用图像分析仪测定每位患者五个无硬化改变的肾小球赤道区域的平均肾小球毛细血管丛面积，并将该值与正常对照组的平均值进行比较。肾小球肥大定义为超过正常对照组平均肾小球毛细血管丛面积+1标准差的值。在14例IgA肾病患者（70.0%）、4例Alport综合征患者（30.7%）和8例FGS患者（66.7%）中发现了肾小球肥大。IgA肾病中肾小球肥大的发生率显著高于Alport综合征，FGS与Alport综合征相比有更高的趋势。在肾功能不全的患者中，6例IgA肾病患者中有4例（66.6%）、5例Alport综合征患者中有0例（0%）、3例FGS患者中有1例（33.3%）出现肾小球肥大，IgA肾病患者肾小球肥大的发生率最高。本研究中最后一次活检与肾功能不全之间的间隔无显著差异。在IgA肾病中，与肾小球毛细血管丛面积小于平均+2标准差的组相比，肾小球毛细血管丛面积超过平均+2标准差的组中废弃肾小球显著增加。FGS病例中废弃肾小球与整个肾小球的比例与肾小球肥大之间无相关性。本研究表明，肾小球肥大可能导致IgA肾病患者肾功能下降，但在Alport综合征中并非如此。（摘要截短至250字）
