Fukuda Y, Ohtomo Y, Kaneko K, Yabuta K
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Am J Nephrol. 1993;13(1):78-82. doi: 10.1159/000168594.
Membranoproliferative glomerulonephritis (type 1) associated with infected ventriculoatrial shunt was observed in an 11-year-old girl. The removal of the shunt and antimicrobial therapy led to rapid improvement in the clinical symptoms, serologic abnormalities, and glomerular alterations. Serum complement levels were initially low and returned to normal values within 1 month. Urinary sediment abnormalities resolved within a few months. Cultures taken from cerebrospinal fluid and the end of the shunt grew Staphylococcus epidermidis. Initial renal biopsy obtained immediately before shunt removal showed membranoproliferative glomerulonephritis (type 1). Repeat biopsy performed 2 years after shunt removal showed moderate improvement of glomerular alterations. This study of pathologic and laboratory changes following therapy suggests that the pathophysiology of the nephritis was based on an immunologic process, and that removal of antigen resulted in reversal of glomerular changes.
一名11岁女孩被观察到患有与感染性脑室心房分流管相关的膜增生性肾小球肾炎（1型）。分流管的移除和抗菌治疗使临床症状、血清学异常及肾小球病变迅速改善。血清补体水平最初较低，并在1个月内恢复至正常水平。尿沉渣异常在数月内得以解决。从脑脊液和分流管末端采集的培养物培养出表皮葡萄球菌。在移除分流管之前立即进行的首次肾活检显示为膜增生性肾小球肾炎（1型）。分流管移除2年后进行的重复活检显示肾小球病变有中度改善。这项关于治疗后病理和实验室变化的研究表明，肾炎的病理生理学基于免疫过程，抗原的移除导致了肾小球变化的逆转。
