Komatsuda A, Yasuda T, Wakui H, Imai H, Miura A B, Sakuyama M, Fukuda T, Nakamoto Y
Third Department of Internal Medicine, Akita University School of Medicine, Japan.
Intern Med. 1993 May;32(5):387-90. doi: 10.2169/internalmedicine.32.387.
A 70-year-old male developed rapidly progressive glomerulonephritis syndrome with serum perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA). A renal biopsy showed diffuse crescentic glomerulonephritis. Immunofluorescence microscopy revealed 2+ granular staining of IgG over the mesangial area and along glomerular capillary walls. Electron microscopy showed scattered deposits in the paramesangial area. These morphologic findings were consistent with those of immune complex type crescentic glomerulonephritis (IC-CGN). Serum C3, C4, and CH50 were within normal limits, and circulating immune complexes were not detected by C1q-binding assay, but both P-ANCA and anti-myeloperoxidase antibodies were positive. A possible relation of P-ANCA to IC-CGN is discussed.
一名70岁男性出现快速进展性肾小球肾炎综合征，伴有血清核周抗中性粒细胞胞浆抗体（P-ANCA）。肾活检显示弥漫性新月体性肾小球肾炎。免疫荧光显微镜检查显示IgG在系膜区和沿肾小球毛细血管壁呈2+颗粒状染色。电子显微镜检查显示系膜旁区有散在沉积物。这些形态学表现与免疫复合物型新月体性肾小球肾炎（IC-CGN）一致。血清C3、C4和CH50在正常范围内，C1q结合试验未检测到循环免疫复合物，但P-ANCA和抗髓过氧化物酶抗体均为阳性。本文讨论了P-ANCA与IC-CGN之间可能的关系。
