Suganuma T
Third Department of Internal Medicine, Nagoya City University, Medical School, Japan.
Nihon Jinzo Gakkai Shi. 1994 Jul;36(7):813-22.
One hundred kidneys from 100 non-selected autopsy cases without any overt renal disease were examined by immunofluorescence to reveal the incidences and features of cases with clinically latent glomerular IgA deposits. Glomerular IgA deposits were found in 10 cases (10.0%), consisting of 4 with liver cirrhosis and 6 with other diseases. IgA deposition was observed in 4 of 13 cirrhotic patients (30.8%), 3 of 15 patients with gastrointestinal carcinoma (20.0%), one of 11 patients with cardiovascular disease (9.1%), one of 3 patients with fulminant hepatitis (33.3%), and one of 21 patients with broncho-pulmonary disease (4.8%). Light microscopy showed minor glomerular abnormalities in all non-cirrhotic cases with IgA deposits except in one case. By contrast, variable significant glomerular lesions were found in the cirrhotic cases with IgA deposits, for example mesangial proliferation and circumferential mesangial inter-position. Excluding 13 cases with liver cirrhosis, the results of urinalysis at the time of admission were available for the study in 55 of 87 cases. Forty-four of 55 cases showed normal urinalysis. Glomerular IgA deposition was found in 4 cases (9.1%) of 44 with normal urinalysis. It may be said that IgA deposition without clinical evidence of nephropathy occurred even in a normal population with an incidence of about 10%.
对100例无明显肾脏疾病的非选择性尸检病例的100个肾脏进行免疫荧光检查,以揭示临床隐匿性肾小球IgA沉积病例的发生率和特征。在10例(10.0%)中发现肾小球IgA沉积,其中4例患有肝硬化,6例患有其他疾病。在13例肝硬化患者中有4例(30.8%)观察到IgA沉积,15例胃肠道癌患者中有3例(20.0%),11例心血管疾病患者中有1例(9.1%),3例暴发性肝炎患者中有1例(33.3%),21例支气管-肺部疾病患者中有1例(4.8%)。除1例病例外,所有非肝硬化的IgA沉积病例的光镜检查均显示肾小球有轻微异常。相比之下,在有IgA沉积的肝硬化病例中发现了各种明显的肾小球病变,例如系膜增生和系膜环周插入。排除13例肝硬化病例后,87例中有55例在入院时可获得尿液分析结果用于本研究。55例中有44例尿液分析正常。在44例尿液分析正常的病例中有4例(9.1%)发现肾小球IgA沉积。可以说,即使在正常人群中也会发生无肾病临床证据的IgA沉积,发生率约为10%。