尿中白细胞介素─6测定与系膜增殖性肾炎病理改变相关分析

目的：探讨尿中ＩＬ┐６测定在系膜增殖性肾炎（ＭｓＰＧＮ）病理诊断、病程监测中的意义。方法：应用生物活性法测定３０例ＭｓＰＧＮ患儿及１５例非系膜增殖性肾炎（Ｎ┐ＭｓＰＧＮ）患儿尿中ＩＬ┐６活性，同时分析其与ＭｓＰＧＮ病理改变的关系。结果：ＭｓＰＧＮ组尿中ＩＬ┐６活性较Ｎ┐ＭｓＰＧＮ组显著增高，中度ＭｓＰＧＮ尿ＩＬ┐６活性较轻度ＭｓＰＧＮ显著增高，且与ＭｓＰＧＮ病理程度密切相关。结论：尿中ＩＬ┐６活性的测定能间接反映肾脏病变类型及程度，监测尿中ＩＬ┐６活性对ＭｓＰＧＮ病理诊断的预计有重要意义     

Small cell anaplastic carcinoma of the lung with mesangial proliferative glomerulonephritis

Mesangial proliferative glomerulonephritis is an uncommon manifestation of renal injury associated with neoplastic disease. A 50-year-old woman with small cell anaplastic cancer of the lung and nephrotic syndrome had renal biopsy findings that were consistent with diffuse mesangial cell proliferation. Electron microscopic evaluation of renal tissue demonstrated numerous intramesangial and paramesangial dense deposits. Resolution of the nephrotic syndrome with improvement in renal function was noted after a response of the patient's tumor to combination chemotherapy.     

The clinical course of mesangial proliferative glomerulonephritis.

Patients with a pure mesangial proliferative glomerulonephritis may present with either hematuria, asymptomatic proteinuria, or nephrotic syndrome. For patients with hematuria, the clinical course is self-limited, and spontaneous resolution of recurrent episodes of macroscopic hematuria occurred in many of these patients. For patients with asymptomatic proteinuria, a spontaneous decrease in proteinuria occurred and none of these patients developed a progressive course. The clinical course of patients with nephrotic syndrome was similar to that usually observed in children and adults with pure minimal change lesions. A complete remission of the nephrotic syndrome occurred in most of these patients during treatment with prednisone and cyclophosphamide. Overall, the prognosis for the patients reported in this series was quite good.     

Increase of plasma adrenomedullin level in mesangial proliferative glomerulonephritis patients is correlated with tubulointerstitial lesion

ObjectiveAdrenomedullin, a recently discovered peptide with hypotensive effects, has been shown to be elevated in glomerular diseases. In this study, we investigated the relationship between the plasma adrenomedullin and renal tubulointerstitial lesion in patients with mesangial proliferative glomerulonephritis.MethodsTwenty-six patients with a normal renal function, diagnosed histologically with mesangial proliferative glomerulonephritis with (n = 1) or without immunoglobulin A composure (n = 25), were enrolled in this study. Eighteen healthy volunteers were enrolled as controls. Patients were divided into two groups according to the degree of tubulointerstitial lesion. Plasma adrenomedullin level was measured by an adrenomedullin-specific radioimmunoassay.ResultsPlasma adrenomedullin concentrations were higher in patients with mesangial proliferative glomerulonephritis than in healthy volunteers (5.71 × 10⁻¹² ± 0.37 × 10⁻¹² vs 2.12 × 10⁻¹² ± 0.15 ×10⁻¹² mol/L; p<0.01). Plasma adrenomedullin was also higher in patients with severe tubulointerstitial lesion than those with mild lesions (6.69 × 10⁻¹² ± 0.25 × 10⁻¹² vs 4.58 × 10⁻¹² ± 0.13× 10⁻¹² mol/L; p<0.01).ConclusionPlasma adrenomedullin concentrations increase in patients with mesangial proliferative glomerulonephritis, and the degree of elevation correlates with tubulointerstitial lesion.     

Polymyositis associated with focal mesangial proliferative glomerulonephritis with depositions of immune complexes

A 58-year-old man concurrently developed polymyositis (PM), interstitial lung disease, and nephrotic-range proteinuria. Renal biopsy revealed focal mesangial proliferative glomerulonephritis (mesPGN) with depositions of immunoglobulin and complements. A combination therapy of corticosteroid, intravenous immunoglobulin, and cyclosporine was found very effective for the patient. Glomerulonephritis associated with PM/dermatomyositis (DM) is rare. In our review of related literature, mesPGN was exclusively observed in polymyositis while membranous nephropathy in DM. The mechanism underlying the association between myositis and glomerulonephritis remains to be elucidated.     

Pathological regression by angiotensin II type 1 receptor blockade in patients with mesangial proliferative glomerulonephritis.

Although angiotensin II type 1 receptor blocker (ARB) therapy reduces proteinuria and retards the progression of renal injury in patients with glomerulonephritis, whether these drugs actually ameliorate pathological damages in human glomerulonephritis has not been determined. Fifteen patients with biopsy-proven mild-to-moderate mesangial proliferative glomerulonephritis (10 with immunoglobulin A [IgA] nephropathy and 5 with non-IgA mesangial proliferative glomerulonephritis) received ARB monotherapy. In these patients, repeated renal biopsy was performed after a mean of 28.1 months, and pathological changes (including the mesangial matrix expansion ratio and interstitial fibrosis expansion ratio) were quantitatively examined using an image analyzer. Clinical markers were also evaluated, including the serum creatinine, serum IgA, creatinine clearance (Ccr), 24-h urinary protein excretion, urinary N-acetyl-beta-D-glucosaminidase (NAG), and blood pressure. ARB therapy significantly reduced urinary protein excretion (0.68+/-0.63 to 0.20+/-0.32 g/day, p=0.016) and the blood pressure (systolic: 133.3+/-18.2 to 123.4+/-10.5 mmHg, p=0.041; diastolic: 79.4+/-11.9 to 72.0+/-8.2 mmHg, p=0.038). Although the global glomerular sclerosis ratio was unchanged (6.3+/-8.5% to 10.7+/-16.1%, p=0.33), the mesangial matrix expansion ratio (33.1+/-10.8% to 22.7+/-7.8%, p=0.001) and the interstitial fibrosis ratio (19.9+/-5.8% to 13.8+/-4.4%, p=0.034) were significantly reduced by ARB treatment. The levels of pathological improvement were similar between patients with IgA nephropathy and those with non-IgA mesangial proliferative glomerulonephritis. The results of the present study strongly suggest that ARB monotherapy can significantly reverse pathological changes, including mesangial matrix expansion and interstitial fibrosis, in human glomerulonephritis.     

糖皮质激素对非IgA系膜增殖性肾炎患者肿瘤坏死因子的影响

目的观察非ＩｇＡ系膜增殖性肾炎患者应用激素前后血清肿瘤坏死因子－α（ＴＮＦ－α）的变化及其与尿蛋白的相关关系。方法３０例非ＩｇＡ系膜增殖性肾炎表现为肾病综合征的患者按病理增生程度不同分为轻度增生组和中重度增生组，两组均在用激素前及用激素后４周及８周测定血清ＴＮＦ－α及２４小时尿蛋白定量。结果两组患者治疗前血清ＴＮＦ－α明显升高，且ＴＮＦ－α水平与系膜增生程度有关，激素治疗后ＴＮＦ－α下降，疗效与系膜增生程度及ＴＮＦ－α水平有关。ＴＮＦ－α与２４小时尿蛋白存在显著正相关。结论对非ＩｇＡ系膜增殖性肾炎患者测定血清ＴＮＦ－α可作为判断组织学损伤的非创伤性参考指标及判断激素疗效与预后的参考指标。     

成人毛细血管内增生性肾炎远期预后分析

目的:探讨成人毛细血管内增生性肾炎的远期预后及影响因素.方法:62例患者分两组:链球菌感染组(n=43);非链球菌感染组(n=19).分析两组患者的临床病理特点.47例随访时间＞12月的患者纳入预后分析.采用单因素及多因素分析影响因素.结果:非链球菌感染组患者的蛋白尿及镜下血尿均高于链球菌感染组.两组患者光镜改变无显著差异.随访＞12月的47例患者完全缓解率为89.4%,慢性肾功能不全及终末期肾病(ESRD)的发生率分别为4.3%和2.1%.单因素分析显示年龄、基础疾病、小管损伤及Clq阳性是影响预后的因素,多因素分析显示基础疾病及蛋白尿是影响预后的重要独立因素.结论:成人毛细血管内增生性肾炎的远期预后良好,肾活检时蛋白尿水平及合并基础疾病是影响预后的重要因素.     

前列腺素E1脂微球载体制剂对系膜增殖性肾炎肾保护作用的研究

目的　探讨前列腺素E1脂微球载体制剂 ( prostaglandinE1incorporatedinlipidmicro spheres ,LipoPGE1)对系膜增殖性肾小球肾炎 (MsPGN)大鼠肾脏的保护作用及其机制。 方法　将大鼠随机分为对照组、MsPGN模型组和MsPGN +LipoPGE1治疗组 3组。采用胃肠道综合免疫方法建立MsPGN模型。 8周后检测各组大鼠尿蛋白和肾功能 ,并观察肾组织病理改变 ,应用免疫组织化学方法检测增殖细胞核抗原 (PCNA)、纤维连接蛋白 (FN)、Ⅳ型胶原蛋白 (ColⅣ )和转化生长因子 (TGFβ1)在肾组织中的表达。 结果　LipoPGE1组大鼠血肌酐水平较MsPGN组降低 (P <0 .0 5 ) ,肾小球系膜及基质增生程度比MsPGN组明显减轻 ,免疫组织化学染色结果显示LipoPGE1组肾小球PCNA、FN、ColⅣ、TGFβ1表达明显低于MsPGN组 (P <0 .0 1)。 结论　LipoPGE1对MsPGN大鼠肾脏有保护作用 ,其机制可能是部分通过下调TGFβ1的表达 ,减少肾小球内细胞增生和细胞外基质 (ECM )沉积     

Long-term renal outcomes of mesangial proliferative lupus nephritis in Chinese patients

Clinical Rheumatology - This study aimed to explore the long-term outcomes of mesangial proliferative lupus nephritis (LN class II) and the factors associated with its relapse and histological...     

Mesangial proliferative glomerulonephritis associated with multiple myeloma

IgA lambda multiple myeloma was diagnosed in a 58-year-old white woman after the onset of nephrotic syndrome. Serial renal histology demonstrated progressive mesangial proliferative glomerulonephritis. Electron microscopy revealed subepithelial electron dense deposits. Immunofluorescence microscopy demonstrated granular staining of peripheral capillary loops with IgG and C3. No IgA was present. No evidence of deposition of the myeloma protein in the glomeruli was found. The temporal relationship of occurrence of the two diseases and the progression of glomerular disease suggest that multiple myeloma be added to the list of malignancies causing immune complex glomerulonephritis.     

Age-related changes in the plasma membrane proteoglycans of rat kidney glomerular cells

In a previous in vivo study, we showed that the glomerular cells of rat kidney synthesize both peripheral and integral plasma membrane proteoglycans. The present work focusses on the age-related changes in these cell membrane proteoglycans. The peripheral proteoglycans in “adult control” rats aged 3 months were found to be heparan sulfate, dermatan sulfate, and chondroitin sulfate, with heparan sulfate being the main glycosaminoglycan. The integral membrane proteoglycans contained mainly dermatan sulfate plus less amounts of heparan sulfate. The relative proportions of the glycosaminoglycans in the integral membrane proteoglycans changed between 1 and 3 months. In addition, the degree of sulfation increased in both families of proteoglycans, and this was associated with an increase in glycosaminoglycan synthesis in the peripheral proteoglycans. The nature and relative proportions of the glycosaminoglycans forming the proteoglycans, did not change with age, after 10 months, and neither did the amount of glycosaminoglycans. But, the degree of sulfation of both peripheral and integral membrane proteoglycans decreased. De novo synthesized proteoglycans from 24-month-old rats had a higher overall charge than did those at other ages, owing to the presence of sulfate and carboxylic groups. We conclude that, as for glomerular basement membrane proteoglycans, biochemical alterations affect the glomerular cell membrane proteoglycans with aging.     

Lupus erythematosus proliferative glomerulonephritis in fetus

We report the case of a fetus with proliferative glomerulonephritis in the context of maternal systemic lupus erythematosus (SLE). The pattern of the renal lesions correspond to the class III of revisited WHO classification of glomerulonephritis in SLE. Amniotic fluid analysis showed a high level of albumin and the presence of anti-Ro and anti-DNA antibodies that were possibly responsible for the renal injury.     

肾移植后复发的单克隆IgG沉积肾小球肾炎

中年男性,6年前发现肾病综合征,虽经治疗但肾功能仍进行性恶化;自体肾肾活检符合单克隆IgG沉积肾小球肾炎.发病后3年因慢性肾功能不全行肾移植术,肾移植术后1年蛋白尿再现,行移植肾活检证实单克隆IgG沉积肾小球肾炎复发.