<原著>糸球体腎炎の発症, 進展因子に関する研究 : 特に, 免疫担当細胞, 糸球体内凝固の役割について

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To clarify the role of immune cell infiltration and fibrin deposition in the glomerular injury, renal biopsy specimens taken from patients with various glomerular diseases were evaluated using well characterized antibodies to immune cells and cross-linked fibrin (XFb). Macrophages/monocytes were the predominant cell type infiltrating the glomerulus in IgA nephritis and Henoch-Schonlein purpura nephritis (HSPN). Intraglomerular macrophage/monocyte population in these two diseases was significantly higher than that in normals, mesangial proliferative (non-IgA) glomerulonephritis or minimal change nephrotic syndrome. In IgA nephritis, there was a clear correlation between glomerular macrophage/monocyte accumulation and the degree of proteinuria. The macrophage/monocyte influx tended to decline with time in HSPN, whereas it tended to persist in IgA nephritis. Glomerular XFb deposition was found in various glomerulonephritis, especially IgA nephritis, HSPN, lupus nephritis and hemolytic uremic syndrome. Dual-label immunofluorescent studies showed that XFb was deposited in limited areas among the sites reactive with anti-fibrinogen antibodies, XFb was not present in the crescents, Bowman's capsule or interstitium. The localization of XFb was generally discordant with that of the platelet membrane antigen or von Willebrand factor antigen. The subendothelial codeposition of XFb and immunoglobulins (IgA with or without IgG), occasionally accompanying C3,was found in the glomeruli of some of the patients with IgA nephritis and/or HSPN. Further, immunoelectron microscopic studies showed that XFb was localized along the glomerular endothelial surface and in the mesangium, and that the distribution of XFb was similar to that of electron dense deposits. Comparing the renal histologies and clinical features of patients with intraglomerular XFb deposition with those of patients without such deposition, in IgA nephritis, mesangial proliferation was more prominent in patients with XFb deposition. Urinary XFb derivatives were detected by the latex agglutination test both in patients with or without glomerular XFb deposition. These data suggest that the macrophage/monocyte system mediates the induction of proteinuria in IgA nephritis, and support the concept that the glomerular fibrin deposition is associated with endothelial/subendothelial and mesangial injuries.
1989-03-25

<原著>糸球体腎炎の発症, 進展因子に関する研究 : 特に, 免疫担当細胞, 糸球体内凝固の役割について

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