発症時急性糸球体腎炎との鑑別が困難であった膜性増殖性糸球体腎炎の1例

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Membranoproliferative glomerulonephritis (MPGN) is a histologically distinct form of primary glomerulonephritis in which there is thickening of glomerular capillary walls as well as increase in mesangial cells. Pathologic changes characteristic of MPGN are noted as presence of diffuse appearance of double contour in glomerular tufts and of diffuse circumferential mesangial interposition. Furthermore, in approximately one fourth of patients there is a marked infiltration of polymorphonuclear leukocytes and monocytes. This patient had proteinuria, hematuria, hypocomple-mentemia after streptococcus pyogenes infection. The first renal biopsy revealed diffuse enlarged glomeruli with glomerular hypercellularity including polymorphonuclear leukocytic and monocytic infiltration. No double contour was found in glomerular tufts. By electron microscopy discrete electron-dense deposits were present on mesangial, subendothelial and subepithelial spaces ("humps"). And circumferential mesangial interposition (CMI) was not at all seen. According to these findings we made a diagnosis of AGN at onset. However, this patient showed persistent hypocomplementemia and increase in proteinuria during a clinical course of the disease which were different from those of AGN. 5 months after the onset the second biopsy showed decrease in glomerular cellularity with moderate polymorphonuclear leukocytic infiltration. A wide spread double contour in glomerular tufts were found. And CMI was broadly observed by electron microscopy. These findings indicated the final diagnosis of this patient was MPGN. In this patient, accurate diagnosis was difficult to be made at onset. In such a case, therefore, serial renal biopsies were useful in making an accurate diagnosis of MPGN.
北里大学の論文
1999-10-31

発症時急性糸球体腎炎との鑑別が困難であった膜性増殖性糸球体腎炎の1例

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