Membranous nephropathy associated with thyroid-peroxidase antigen
Membranous nephropathy associated with thyroid-peroxidase antigen
复制标题
DOI：
10.1007/s00467-008-0973-0
复制
发表时间：
2009-03-01
影响因子：
3
通讯作者：
Yoshikawa, Norishige
中科院分区：
文献类型：
--
作者：
Shima, Yuko;Nakanishi, Koichi;Yoshikawa, Norishige
一名原本健康的 6 岁日本女孩，根据学校例行体检结果，发现试纸 2+ 蛋白尿和甲状腺肿大。血清游离甲状腺素水平为4.98 ng/dL（正常范围0.95-1.74 ng/dL），促甲状腺激素（TSH）小于0.003 mu U/mL（0.34-3.88 mu U/mL），抗微粒体（抗甲状腺过氧化物酶）抗体为1600 T（最高100），抗甲状腺球蛋白抗体为 400 T（最高 100），TSH 受体抗体为 84%（最高 +/- 10%）。这些结果与格雷夫斯病的诊断一致。肾活检标本的电子显微镜检查显示位于上皮下空间的电子致密沉积物，免疫荧光显微镜检查显示沿肾小球毛细血管壁有明亮的免疫球蛋白 G 颗粒染色。这些发现是膜性肾病的特征。为了研究膜性肾病和格雷夫斯病之间的关系，我们进行了第二项免疫荧光研究，结果显示免疫球蛋白 G 颗粒沉积物对应于甲状腺过氧化物酶的肾小球颗粒染色，而甲状腺球蛋白染色不存在。因此，推测甲状腺过氧化物酶介导的免疫复合物沉积导致了该患者的膜性肾病。这是与格雷夫斯病相关的膜性肾病的第一份报告，其中已证实肾脏中有甲状腺过氧化物酶而不是甲状腺球蛋白的沉积。
A 6-year-old previously healthy Japanese girl was found to have dipstick 2+ proteinuria and a goiter based on the results of a routine school medical examination. Her serum free-thyroxine level was 4.98 ng/dL (normal range 0.95-1.74 ng/dL), thyroid-stimulating hormone (TSH) was less than 0.003 mu U/mL (0.34-3.88 mu U/mL), anti-microsomal (anti-thyroid-peroxidase) antibody was 1600 T (up to 100), anti-thyroglobulin antibody was 400 T (up to 100), and TSH-receptor antibody was 84% (up to +/- 10%). These results are consistent with a diagnosis of Graves' disease. Electron microscopy examination of a renal biopsy specimen revealed electron-dense deposits located in the subepithelial spaces, and immunofluorescence microscopy examination demonstrated bright granular stainings of immunoglobulin G along the glomerular capillary walls. These findings are characteristic of membranous nephropathy. To investigate the relationship between the membranous nephropathy and Graves' disease, we carried out a second immunofluorescence study, which revealed that the immunoglobulin G granular deposits corresponded to glomerular granular staining of thyroid-peroxidase, whereas staining for thyroglobulin was absent. It was therefore assumed that the deposition of immune complexes mediated by thyroid-peroxidase had caused the membranous nephropathy in this patient. This is the first report of membranous nephropathy associated with Graves' disease in which deposits of thyroid-peroxidase, rather than thyroglobulin, have been confirmed in the kidney.