Oliveira D B
Division of Renal Medicine, St George's Hospital Medical School, London, UK.
Lancet. 1998 Feb 28;351(9103):670-1. doi: 10.1016/S0140-6736(97)04122-6.
Membranous nephropathy is characterised by the deposition of immunoglobulin, predominantly of the IgG4 subclass, along the epithelial surface of the glomerular-basement membrane. Current models of pathogenesis usually assume in-situ immune-complex formation involving an as yet uncharacterised fixed glomerular antigen. I argue that the properties of IgG4 (inability to fix complement and therefore impaired clearance of IgG4-containing complexes; low affinity and therefore ability for IgG4-containing complexes to dissociate and traverse the glomerular-basement membrane) are compatible with a pathogenic mechanism that involves the deposition of circulating IgG4 immune complexes containing diverse antigens.
膜性肾病的特征是免疫球蛋白（主要是IgG4亚类）沿肾小球基底膜上皮表面沉积。目前的发病机制模型通常假定存在原位免疫复合物形成，涉及一种尚未明确的固定肾小球抗原。我认为，IgG4的特性（无法固定补体，因此含IgG4的复合物清除受损；低亲和力，因此含IgG4的复合物能够解离并穿过肾小球基底膜）与一种致病机制相符，该机制涉及含有多种抗原的循环IgG4免疫复合物的沉积。
