肥胖相关性肾病:临床表现、组织学及超微结构特征

Clinical,histological and ultrastructural characteristics of obesity-related glomerulopathy

目的 :分析肥胖相关肾脏损害的临床表现、实验室检查特点及肾活检组织学改变和超微结构特征。 方法 :收集 2 0 0 0年 8月～ 2 0 0 2年 8月因肾脏疾病行自体肾经皮肾活检 15例患者体重指数 (BMI) >2 8kg/m2 ,组织学改变符合ORG ,并按组织学改变特点将其分为单纯肥胖相关的肾小球肥大组 (O GM) (n =8)和肥胖相关的局灶节段性肾小球硬化伴肾小球肥大组 (O FSGS) (n =7) ,对比分析患者的临床表现 ,实验室检查结果及肾活检组织学和超微结构特点。 结果 :本组 80 %的患者存在非肾病范围的以中等分子量 (Mr)为主的蛋白尿 ,33%的患者存在镜下血尿 ,无贫血。血清三酰甘油升高者较胆固醇升高者多 (分别为 5 3 3%和 4 0 % ) ,4 6 7%的患者血尿酸升高 ,高胰岛素血症常见 (3/5例 ) ,此外 5例患者谷丙转氨酶升高 (33 3% ) ,5 4 5 %的患者肝脏B超检查存在脂肪肝。组织学改变表现为肾小球体积增大 ,伴 /不伴节段硬化 ,其它形态学改变如透明变性、内皮性泡沫细胞及顶部病变等也见于ORG患者。电镜观察足突融合、微绒毛化不广泛 ,但早期即存在基膜增厚。 结论 :非肾病范围的中Mr的蛋白尿及代谢异常为ORG患者最常见的临床表现 ,部分患者存在镜下血尿 ,谷丙酶升高及脂肪肝。组织学改变表现为肾小球体积增大 ,伴

Objective:To investigated the clinical, histological and ultrastructural features of obesity-related glomerulopathy (ORG). We reviewed the native renal biopsies from Aug. 2000 to Aug. 2002, 15 patients, whose BMI more than 28 kg/m 2, were diagnosed ORG. They were 13 males and 2 female with a mean of (32 64±8.06) years old. According to the morphologic lesions, two groups of ORG were divided. They were glomerulomegaly alone (O-GM, group Ⅰ , n =8) and focal segmental glomerulosclerosis with glomerulomegaly (O-FSGS, group Ⅱ, n =7). Their clinical and laboratory findings were analyzed and compared. non-nephrotic range protienuria comprised of medium size molecule was encountered in 80% patients, microscopic hematuria in 33% cases. No anemia was found in any patient. Hypertriglyceridemia was more prevalent than hypercholesterolemia in ORG patients (respectively 53 3% and 40%), Elevated serum uric acid occurred in 7 patients (46 7%), hyperinsulinemia in 3/5 cases, elevated AST in 5 cases (33 3%). Liver sonography showed fatty liver in all patients. Glomerulomegaly was the specific feature in all sections with or without segmental sclerosis. Hyaline and foam cell located in glomerular capillary lumen and tip lesion occurred in some cases with O-FSGS, occasionally in patients with O-GM. Ultrastructural changes indicated mild podocyte effacement and microvilli, but the thickened glomerular basement membrane existed in early stage.ORG manifests with non-nephrotic range proteinuria. The morphologic features include glomerulomegaly without/with FSGS and thickened GBM in the early stage.