ヒト慢性糸球体腎炎に関する形態学的研究 : 走査型電子顕微鏡による腎糸球体上皮細胞障害度分類の提唱
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Morphological Studies on Human Chronic Glomerulonephritis with Special Reference to Grading of Glomerular Epitherial Cell Deformities by Scanning Electron Microscopy
Scanning electron microscopy (SEM) observations were made of kidney biopsy materials, particularly the epithelial cells of the glomerulus, collected from 60 patients with chronic glomerulonephritis. The results are as follows.
1. The epithelial cells are composed of cell body and processes which could be classified morphologically into five grades.
Grade 0 Processes branching from the epithelial cell body present a regular pattern up to the periphery where they interdigitate with adjacent processes in an orderly manner in the periphery as in the cell structure of the normal kidney.
Grade 1 Processes branch orderly up to the periphery, but become swollen in the periphery.
Grade 2 Some of the processes become swollen, fused or have disappeared.
Grade 3 Processes become fused irregularly and present mica-like structure.
Grade 4 The glomerulus becomes hyalinized.
2. As the grade of epithelial cell changes increases, the frequency of edema, early morning urine protein volume, 24-hour total urine protein volume, WBC, plasma fibrinogen value, BSR, BUN, serum creatimne value, serum cholesterol value and serum triglyceride value all became significantly increased.
3. As the grade of epithelial cell changes increases, urine output volume, RBC, hemoglobin value, hematocrit value, total serum protein, serum albumin value, serum calcium value, RBF, GFR, PSP 15-minutes value, Ccr. value,serum IgG value, and CH50 value became significantly decreased.
4. A significant correlation could not be observed between grade of epithelial cell and blood pressure value, degree of hematuria, platelet count, bleeding time, coagulation time, prothrombin time, frequency of positive CRP, ASLO value, frequency of positive RA factor, serum sodium value, serum potassium value, serum chloride value, serum phosphorus value, serum IgA value, serum lgM value, C3 value and C4 value.
5. A significant positive correlation was observed between the grade of epithelial cell changes and thickening of the basement membrane of the glomerulus.
6. A significant positive correlation was noticed between the grade of epithelial cell changes and proliferation of mesangial cells.
7. A significant positive correlation was present between the grade of epithelial cell changes and IgG deposit on the glomerulus, but no such significant correlation could be demonstrated between IgA, IgM norfibrinogen deposit.
8. The author proposes the use of his grading of changes in the glomerular epithelial cells for classification of cell damage in the routine diagnosis of renal pathology material. That is, Grade 0 is classified as Damage Grade 0, Grade 1 corresponds to Damage Grade 1, Grade 2 to Damage Grade 2, Grade 3 to Damage Grade 3 and Grade 4 to Damage Grade 4.
9. It was found that the glomerular epithelial cells become the final barrier against the production of proteinuna.
10. Proliferation of microvilli can be observed on the surface of the glomerular epithelial cells in some cases.
広島大学医学雑誌, 28(6), 711-764, 昭55-12月(1980)
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