肝硬化性肾小球肾炎7例临床与尸解

CLINICAL FEATURES AND AUTOPSY FINDINGS OF KIDNEY INVOLVNENT IN 7 CASES OF CIRRHOSIS OF LIVER A RETROSPECTIVE STUDY

11例肝硬化患者尸解,病理显示有肾损害者7例,占64％,光镜下均见不同程度系膜细胞及系膜基质的增多,系膜区有免疫复合物IgA、C_3、IgG沉积;7例肾损害者其中肾功受累6例,占85.7％;也有呈蛋白尿、血尿、管型尿。本文探讨了肝硬化性肾小球肾炎的诊断,本病的预后取决于肝病的程度。

Clincal features and autopsy findings of kidney involvement in 7 cases of cirrhosis of liver were analysed retrospectively. All 7 cases had a history of cirrhosis or liver cancer after hepatitis, Among them, 5 had HBsAg positive. Autopsy specimens of kidney were examined under light microscope and with immunohistochemistry. Among the 7 cases, 6 had clinical evidence of kidney involvement, proteinurea in 2 (28.5%), microscopic hematuria and urinary cast in 6 (85.7%). Histologic examination showed glomerular changes in 7 (100%), diffuse MsPGN in 7 (100%). With PAS+Masson stain, immunocomplex desposits were found in mesangium in 7 (100%). By immuno-histochemistry examination IgA deposits were found in mesangium in 6 (86 %) with homogeneous Cs deposition in 6 (86%). All 7 patients died of cirrhotic complications, hemorrhoge of digestive tract in 4 (57.1%), hepatic coma in 3 (43%). Our data suggested that glomerulonephritis complicated with cirrhosis of liver caused by hapatitis was common. The basic histology change was MsPGN with mesangial IgA & C_3 deposition.