膜增生性肾小球肾炎样病变免疫荧光分类法改良的探讨

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Abstract Objective: To explore the improvement of immunofluorescence (IF) classification of membranoproliferative glomerulonephritis (MPGN) like lesion, to understand the etiology of MPGN like lesions and the prevalence of idiopathic MPGN. Methods: MPGN like lesions were diagnosed by optical microscopic examination of renal biopsy tissues in 118 patients from January 1994 to April 2018 in the First Affiliated Hospital of Wenzhou Medical University. All these cases were studied by a modified method of IF classification based on IF classification which had been suggested by SETHI and FERVENZA, and combined with electron microscopic examination and clinical retrospective etiological analysis. Results: A total of 118 cases of MPGN like lesions, with an average age of 39.8±17.2 years old, including 12 cases of idiopathic MPGN and 9 738 cases of renal biopsy in the same period. Idiopathic MPGN accounted for 0.12% of the total cases of renal biopsy. According to the improved IF classification, immune-complex (IC) mediated MPGN accounted for 78.8% (93/118), monoclonal immunoglobulin related MPGN accounted for 5.9% (7/118), C3 glomerulopathy and non immuno-mediated MPGN like lesions accounted for 8.5% (10/118) and 6.8% (8/118) respectively. Etiological classification: idiopathic MPGN accounted for 10.2% (12/118), the cases with secondary causes accounted for 89.8% (106/118), the most common secondary cause was systemic lupus erythematosus (SLE) which accounted for 34.7% (41/118), followed by hepatitis B virus (HBV) infection which accounted for 12.7% (15/118). Electron microscopy revealed 77 cases of MPGN like lesions, including 73 cases of MPGN and 4 cases of MPGN like lesions. The most frequent pathological type of MPGN was I type, accounting for 56.2% (41/73), followed by III type 41.1% (30/73). Secondary MPGN was 78.1% (32/41) and 90% (27/30) in type I and III respectively. Conclusion: The prevalence of idiopathic MPGN in Wenzhou is extremely low. Most of the cases with MPGN like lesions have secondary etiology which are common caused by SLE and HBV infection, and in which MPGN is the most common mediated by IC. The modified method of IF classification can lead to an improved understanding of the pathogenic mechanism in MPGN, and may be more helpful to the etiological identification of MPGN like lesions.

Key words： glomerulonephritis, membranoproliferative immune-complex C3 glomerulopathy monoclonal immunoglobulin

Received: 21 March 2018

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	LI Chang
	ZHU Shuang
	HUANG Zhaoxing.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2018/V48/I9/646

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