Markowitz G S, Cheng J T, Colvin R B, Trebbin W M, D'Agati V D
Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
J Am Soc Nephrol. 1998 Dec;9(12):2244-52. doi: 10.1681/ASN.V9122244.
The most common form of glomerular disease seen in association with hepatitis C virus (HCV) infection is membranoproliferative glomerulonephritis, with or without associated cryoglobulinemia. This study examines four cases of fibrillary glomerulonephritis and two cases of immunotactoid glomerulopathy in association with HCV infection. Findings at presentation included proteinuria, renal insufficiency, and hematuria. Renal biopsy revealed a membranoproliferative pattern of glomerular disease in five cases, and a membranous glomerulopathy with mesangial proliferative features in one. On immunofluorescence, all cases stained with IgG and C3. Electron microscopy revealed fibrils of the expected diameter, 16 to 28 nm in fibrillary glomerulonephritis and 33 to 45 nm in immunotactoid glomerulopathy. In only one case were cryoglobulins detected (at low titer and on only one of three assays). Antiviral therapy was not given in any of the six cases. Outcomes were mixed, with progression to renal failure occurring in two patients and persistent proteinuria with stable or improved renal function in three. Follow-up is not available on the sixth case. Both fibrillary glomerulonephritis and immunotactoid glomerulopathy have features that overlap with cryoglobulinemic glomerulonephritis. The relatedness of these three entities in a subset of patients with HCV infection suggests a common pathogenic mechanism of glomerular deposition of organized deposits.
与丙型肝炎病毒（HCV）感染相关的最常见肾小球疾病形式是膜增生性肾小球肾炎，伴或不伴有冷球蛋白血症。本研究调查了4例与HCV感染相关的纤维性肾小球肾炎和2例免疫触须样肾小球病。就诊时的表现包括蛋白尿、肾功能不全和血尿。肾活检显示，5例为膜增生性肾小球疾病模式，1例为具有系膜增生特征的膜性肾小球病。免疫荧光检查显示，所有病例均有IgG和C3染色。电子显微镜检查显示，纤维性肾小球肾炎中纤维直径为16至28nm，免疫触须样肾小球病中纤维直径为33至45nm，均符合预期。仅1例检测到冷球蛋白（滴度低，且仅在三项检测中的一项检测到）。6例患者均未接受抗病毒治疗。结果不一，2例患者进展为肾衰竭，3例患者蛋白尿持续存在，但肾功能稳定或改善。第6例患者无随访信息。纤维性肾小球肾炎和免疫触须样肾小球病均具有与冷球蛋白血症性肾小球肾炎重叠的特征。在一部分HCV感染患者中，这三种疾病的相关性提示了有组织沉积物肾小球沉积的共同致病机制。
