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作者报道膜增生性肾小球肾炎伴丙型肝炎病毒(HCV)感染8例,7男,1女,平均年龄50岁,5例白人,3例亚裔。有肝炎或肝功能异常史,就诊时主要表现为高血压、肝肿大及周围性水肿。8例均有蛋白尿,7例肌酸酐廓清率下降。肾活检为膜增生性肾炎,表现为肾小球细胞增多,呈分叶状,灶性小管萎缩,间质内轻度炎性浸润。3例有轻至中度系膜硬化,有的有较多硬化的小球。免疫荧光显示小球毛细血管拌有大量IgM、IgG和C3沉积。4例电镜下在内皮下和系膜区可见沉积物,偶亦见于膜内,其中3例见环状、细纤维状或圆柱状的结构,可能为冷球蛋白。8例血中均查到抗-HCV(重组免疫印迹法)和HCVRNA(PCR法),尿中有低水平HCV RNA
The authors report 8 cases of membranoproliferative glomerulonephritis with hepatitis C virus (HCV) infection, 7 males and 1 female with an average age of 50 years, 5 white and 3 Asians. Hepatitis or liver dysfunction history, mainly for the treatment of hypertension, hepatomegaly and peripheral edema. 8 cases had proteinuria, 7 cases of creatinine clearance rate decreased. Renal biopsy for membranoproliferative glomerulonephritis, showed increased glomerular cells, lobulated, focal tubule atrophy, interstitial mild inflammatory infiltration. 3 patients had mild to moderate mesangial sclerosis, while others had more sclerosis. Immunofluorescence showed that glomerular capillaries mixed with a large amount of IgM, IgG and C3 deposition. 4 cases of electron microscopy under the endothelium and mesangial area visible sediments, even in the membrane also found in 3 cases, see the ring, fine fibrous or cylindrical structure, may be cryoglobulin. Anti-HCV (recombinant immunoblotting) and HCV RNA (PCR) were detected in 8 cases of blood, and low levels of HCV RNA in urine