Hishiki T, Tomino Y, Inokuchi S, Shirato I, Ebihara I, Kubota M, Nakayama S, Koide H
Department of Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 1994 Aug;36(8):942-6.
Two adult patients with mesangial proliferative glomerulonephritis with diffuse IgM deposition in the glomeruli are reported. Case 1 was a 25-year-old female with nephrotic syndrome who showed complete remission after treatment with prednisolone (PSL). Case 2 was a 46-year-old male with asymptomatic proteinuria who showed incomplete remission (0.5-1.0 g/24 hr) of urinary protein without any medication. In light microscopy, these patients revealed minimal or slight proliferation of glomerular mesangial cells without glomerular sclerosis and crescent formation. Deposition of IgM and C3 was observed in the glomerular mesangial areas and capillary walls by immunofluorescence. Electron-dense deposits were observed in the glomerular mesangial areas in these patients. Mesangial proliferative glomerulonephritis associated with diffuse IgM deposition in the glomeruli appears to have a benign clinical course. It has also been suggested that this disease has variant clinical courses since we recently experienced two other patients with mesangial proliferative glomerulonephritis with focal IgM deposits who showed renal tubular dysfunction or chronic renal failure.
报告了两名患有系膜增生性肾小球肾炎且肾小球内有弥漫性IgM沉积的成年患者。病例1是一名25岁患有肾病综合征的女性，经泼尼松龙（PSL）治疗后完全缓解。病例2是一名46岁患有无症状蛋白尿的男性，未接受任何药物治疗，尿蛋白呈不完全缓解（0.5 - 1.0 g/24小时）。在光学显微镜下，这些患者显示肾小球系膜细胞仅有轻微或轻度增生，无肾小球硬化和新月体形成。通过免疫荧光观察到IgM和C3沉积于肾小球系膜区和毛细血管壁。在这些患者的肾小球系膜区观察到电子致密沉积物。与肾小球内弥漫性IgM沉积相关的系膜增生性肾小球肾炎似乎具有良性临床病程。也有人提出，由于我们最近还遇到另外两名患有局灶性IgM沉积的系膜增生性肾小球肾炎患者，他们表现出肾小管功能障碍或慢性肾衰竭，所以这种疾病具有不同的临床病程。
