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患者15岁,男性,因水痘、肾炎和肾病综合征、肾功能损伤、补体C3下降2个月而入北京中日友好医院肾内科治疗,肾活检证实为毛细血管内增生性肾小球肾炎伴足细胞增生和肾小管损伤,直接免疫荧光显示IgG、IgA、IgM、C3、C1q和纤维蛋白原沿肾小球毛细血管壁和系膜区颗粒状和团块状沉积,透射电子显微镜检查显示电子致密物在肾小球多部位沉积,血清中抗水痘病毒抗体(IgM)阳性,免疫组织化学和原位杂交显示水痘病毒抗原和mRNA存在于肾小球和肾小管上皮细胞,特殊染色和透射电子显微镜显示病毒颗粒和病毒包涵体存在于肾小球和肾小管上皮细胞内。患者住院期间尚有癫痫发作,脑电图及核磁共振证实为病毒性脑炎导致的癫痫,故确诊为水痘病毒感染伴发肾小球肾炎和脑炎。这是1例通过分子病理学方法证实水痘病毒在肾内感染导致的肾小球肾炎。
Patients 15 years old, male, due to chickenpox, nephritis and nephrotic syndrome, renal impairment, complement C3 decreased 2 months into the Beijing Sino-Japanese Friendship Hospital, Department of Nephrology, renal biopsy confirmed capillary proliferative glomerulonephritis with Podocyte proliferation and tubular injury. Immunofluorescence showed that IgG, IgA, IgM, C3, C1q and fibrinogen were granular and massive deposition along the glomerular capillary wall and mesangial area. Transmission electron microscopy showed that electron Dense deposits in glomerular multi-site serum anti-varicella antibody (IgM) positive, immunohistochemistry and in situ hybridization showed that varicella virus antigen and mRNA exist in the glomerular and renal tubular epithelial cells, special staining and transmission electron Microscopy showed that virus particles and virus inclusions were present in glomeruli and tubular epithelial cells. Patients with seizures during hospitalization, EEG and MRI confirmed epilepsy caused by viral encephalitis, it was diagnosed as varicella virus infection associated with glomerulonephritis and encephalitis. This is a case of molecular pathology confirmed by varicella virus in renal infection caused by glomerulonephritis.