Alexopoulos E, Leontsini M, Papadimitriou M
Department of Nephrology, Aristotelian University of Thessaloniki, Greece.
Nephrol Dial Transplant. 1994;9(6):623-9. doi: 10.1093/ndt/9.6.623.
Mononuclear inflammatory cells were retrospectively analysed using monoclonal antibodies in the interstitium and glomeruli of 16 renal biopsy specimens from patients with nephrotic syndrome due to idiopathic membranous nephropathy (IMN). The aim of the study was to determine the composition of the infiltrate and to assess the ability to predict the response of proteinuria to corticosteroids. All patients had received prednisolone as a sole treatment. Nine patients had shown a complete or partial remission of proteinuria (group A) and seven did not respond at all (group B). Both groups were matched for age and degree of proteinuria; also both groups had normal renal function at the time of biopsy. Very few intraglomerular leukocytes, mostly monocytes/macrophages (MM) were found. The majority of interstitial T cell population and B cells were a minor component. No significant differences were found between the two groups regarding the types of the intraglomerular cells. However, interstitial T-cells, CD4+ve T helper/inducer cells, CD8+ve T cytotoxic/suppressor cells and MM were significantly higher in group A than in group B. Also HLA-DR expressing interstitial cells were much in excess in group A. In addition patients with complete remission of proteinuria had higher numbers of interstitial cells compared to those with partial response. There was no correlation between the numbers of types of intraglomerular and interstitial cells and the degree of proteinuria at presentation. Also no association was found between intraglomerular or interstitial cell population and subsequent relapse of proteinuria. In conclusion, interstitial but not intraglomerular mononuclear cells seem to determine the initial response of proteinuria to corticosteroids in patients with IMN.
使用单克隆抗体对16例特发性膜性肾病（IMN）所致肾病综合征患者的肾活检标本间质和肾小球中的单核炎性细胞进行回顾性分析。本研究的目的是确定浸润细胞的组成，并评估预测蛋白尿对皮质类固醇反应的能力。所有患者均接受泼尼松龙作为唯一治疗。9例患者蛋白尿完全或部分缓解（A组），7例完全无反应（B组）。两组在年龄和蛋白尿程度上相匹配；两组在活检时肾功能均正常。肾小球内白细胞极少，主要是单核细胞/巨噬细胞（MM）。间质T细胞群体占多数，B细胞是次要成分。两组在肾小球内细胞类型方面未发现显著差异。然而，A组间质T细胞、CD4 + T辅助/诱导细胞、CD8 + T细胞毒性/抑制细胞和MM显著高于B组。此外，A组中表达HLA - DR的间质细胞也多得多。另外，蛋白尿完全缓解的患者与部分缓解的患者相比，间质细胞数量更多。肾小球内和间质细胞的数量及类型与就诊时蛋白尿程度之间无相关性。肾小球内或间质细胞群体与蛋白尿随后复发之间也未发现关联。总之，在IMN患者中，似乎是间质而非肾小球内的单核细胞决定了蛋白尿对皮质类固醇的初始反应。
