Reflux nephropathy の病理学的検討

Abstract

膀胱尿管逆流症(VUR)約400例中13例について, 病理組織学的に検討した.1)組織学的所見上特徴的に認められた尿細管腔の空胞変性および円柱(円柱内空胞), 糸球体におけるメサンギウムの増加は, intrarenal refuxがVURによる腎障害の機序, つまりreflux nephropathyの発生要因として強く働いていることが示唆された.2)蛍光抗体法において, IgM, IgG, C3の糸球体への染色陽性所見を認めたことは, 糸球体が障害される機序として逆流という水力学的な直接作用のみで糸球体病変がすべて発生すると言い切れないことを示しておりreflux nephropathyの発生には免疫学的機序の関与も全く否定できなかった.3)糸球体病変の強く現れたものが蛋白尿を呈したり, 予後不良に陥るというとが組織学的検討から明らかになったが, これはreflux nephropathyの予後が糸球体病変の程度に影響されることを示していると考えた

Four hundred patients with primary vesicoureteral reflux were followed clinically in our department between 1975 and 1984. Histopathological studies including immunofluorescent study were carried out on 13 of them. Their renal function was followed by intravenous pyelography, and from serum creatinine values, proteinuria and radioisotope renograms. Renal deterioration was found in 4 patients. Proteinuria was observed since the first consultation in three of them. Microscopically, mesangial proliferation was observed in all patients but none of them showed focal glomerulosclerosis. An immunofluorescent study was carried out on 7 patients. IgM deposition was found in 3 patients (43%), C8 deposition in only 2 of 3 patients (29%), IgG deposition in 1 of them (14%), and IgA deposition in 1 patient (14%). Proteinuria, renal disorders and mesangial proliferation were correlated with reflux nephropathy. Especially, intrarenal reflux could cause reflux nephropathy but it is impossible to deny immunological factors.