Haramoto T, Makino H, Ikeda S, Wieslander J, Ota Z
Third Department of Internal Medicine, Okayama University Medical School, Japan.
Am J Nephrol. 1994;14(1):30-6. doi: 10.1159/000168682.
Membranous glomerulonephritis (MN) is characterized by the presence of subepithelial immune complexes and thickening of the glomerular basement membrane (GBM). Immune complexes are recognized as subepithelial electron-dense deposits (EDDs) by electron microscopy. We used immunogold electron microscopy to detect the GBM components--type IV collagen, heparan sulfate proteoglycan (HS-PG) and laminin--in thickened GBM, and studied the relationship between immune complexes and these GBM components. We demonstrate that the three major basement membrane components are distributed throughout the newly synthesized GBM. These findings suggest that type IV collagen, HS-PG, and laminin together comprise the spike-like structures and the newly synthesized GBM-like matrix in the thickened GBM of idiopathic MN and membranous lupus nephritis. The newly constructed matrix in the GBM appears to be composed of nearly normal GBM. In type IV collagen, the alpha 1-chain was rarely present on the newly synthesized basement membrane in the lamina rara externa, while alpha 3-chain was present on the subepithelial newly synthesized basement membrane. HS-PG was found within EDDs in membranous lupus nephritis. This suggests that anti-DNA antibody may cross-react with the HS-PG component of the GBM and thus form a subepithelial immune complex.
膜性肾小球肾炎(MN)的特征是上皮下免疫复合物的存在以及肾小球基底膜(GBM)增厚。通过电子显微镜,免疫复合物被识别为上皮下电子致密沉积物(EDDs)。我们使用免疫金电子显微镜检测增厚的GBM中的GBM成分——IV型胶原、硫酸乙酰肝素蛋白聚糖(HS-PG)和层粘连蛋白,并研究免疫复合物与这些GBM成分之间的关系。我们证明这三种主要的基底膜成分分布于整个新合成的GBM中。这些发现表明,IV型胶原、HS-PG和层粘连蛋白共同构成了特发性MN和膜性狼疮性肾炎增厚的GBM中的钉突样结构和新合成的类GBM基质。GBM中新构建的基质似乎由近乎正常的GBM组成。在IV型胶原中,α1链在新合成的外疏松层基底膜中很少出现,而α3链存在于上皮下新合成的基底膜中。在膜性狼疮性肾炎的EDDs中发现了HS-PG。这表明抗DNA抗体可能与GBM的HS-PG成分发生交叉反应,从而形成上皮下免疫复合物。