Yamamoto T, Nagase M, Hishida A, Honda N
First Department of Medicine, Hamamatsu University School of Medicine, Japan.
Lupus. 1993 Aug;2(4):261-8. doi: 10.1177/096120339300200410.
The significance of interstitial inflammatory and chronic tubulointerstitial lesions was studied in relation to the severity of glomerular lesions in 62 patients with lupus nephritis and 88 with IgA nephropathy. Severe interstitial inflammatory and chronic tubulointerstitial lesions were found in patients with severe glomerular lesions in both lupus nephritis and IgA nephropathy. In such cases, the serum creatinine levels at biopsy were high and the renal prognosis was poor regardless of the underlying disease (lupus nephritis or IgA nephropathy). No IgA nephropathy patients with nil or mild glomerular lesions had moderate or severe interstitial inflammatory and/or chronic tubulointerstitial lesions. In contrast, predominantly severe interstitial inflammatory lesions were found in 36% of lupus nephritis patients with nil or mild glomerular lesions. The prevalence of interstitial immune complexes deposition was markedly high in those with predominant interstitial inflammatory lesions. However, the severity of chronic tubulointerstitial lesions was mild and renal function did not deteriorate in the mean follow-up periods of 68.6 months. It is suggested that, besides the tubulointerstitial lesions attributable to the severe concomitant glomerular damage, the interstitial deposition of immune complexes per se plays a pathogenic role in the interstitial inflammatory lesions in lupus nephritis. Its prognostic significance, however, was considered to be minor.
研究了62例狼疮性肾炎患者和88例IgA肾病患者的间质炎症和慢性肾小管间质病变与肾小球病变严重程度的关系。在狼疮性肾炎和IgA肾病中，严重的肾小球病变患者均存在严重的间质炎症和慢性肾小管间质病变。在这些病例中，活检时的血清肌酐水平较高，无论潜在疾病（狼疮性肾炎或IgA肾病）如何，肾脏预后均较差。没有肾小球病变为无或轻度的IgA肾病患者出现中度或重度间质炎症和/或慢性肾小管间质病变。相比之下，在肾小球病变为无或轻度的狼疮性肾炎患者中，36%主要存在严重的间质炎症病变。间质免疫复合物沉积的发生率在主要存在间质炎症病变的患者中明显较高。然而，慢性肾小管间质病变的严重程度较轻，在平均68.6个月的随访期内肾功能并未恶化。提示除了严重的伴随性肾小球损伤导致的肾小管间质病变外，免疫复合物本身的间质沉积在狼疮性肾炎的间质炎症病变中起致病作用。然而，其预后意义被认为较小。
