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사구체 질환으로 발현된 혈청 HBsAg 양성 환자에서 간 및 신장의 조직소견 |
윤형진 , 임춘수 , 정윤철 , 안규리 , 한진석 , 김성권 , 이정상 , 신영태 , 이종호 |
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Abstract |
As a systemic disease, the clinical manifestations of chronic hepatitis B virus(HBV) infection are various, and glomerulonephritis is one of them. Various chronic liver diseases, caused by other than HBV, may cause glomerular changes. And glome- rulonephritis associated with chronic HBV infection is influenced by hepatic dysfunction itself as well as chronic HBV antigenemia. To elucidate the patho- logic findings of liver according to evidence of clinical liver disease in patients presented with clinical glomerular disease and positive serum HBsAg, and to evaluate the influence of hepatic dysfunction in the pathogenesis of glomerulonephritis associated with chronic HBV infection, we analyzed the pathologic findings of the liver and kidney. The pathologic findings of liver were classified as minor group(no diagnostic abnormalities consistent with chronic hepatitis or cirrhosis, 7 males and 2 females), chronic persistent hepatitis(CPH) group(10 males and 2 females), chronic active hepatitis(CAH) group(22 males and 4 females), and liver cirrhosis (LC) group(11males and 3 females). Liver function test was normal(AST and ALT< x 2 of upper normal value) in 40 among 60 patients, and of them, 6 patients in minor group, 9 in CPH group, 15 in CAH group, and 10 in LC group. Abnormal liver function test was observed in 20 patients, and of them, 2 in minor group, 3 in CPH group, 11 in CAH group, and 4 in LC group. The clinical features such as hy- pertension, microscopic hematuria, amount of 24 hour urine protein, and serum creatinine level showed no difference according to the liver pathology. The positive rate of rheumatoid factor was significantly higher in CAH and LC group than in minor and CPH group. Other laboratory tests showed no significant differences. Light microscopic findings of renal biopsy were compaired according to liver pathology and only glomerular basement membrane thickening was observed more frequently in CPH, CAH, and LC group than minor group(P<0.05). The immunofluorescent and electron microscopic findings according to liver pathology showed no differences. Although there was no statistical significance, mem- branous nephropathy was predominant in CPH and CAH group, and mesangial change and diffuse proliferative glomerulonephritis was predominant in LC group. These results suggest that in the pathogenesis of glomerular diseases associated with HBV infection, the role of hepatic dysfunction may be negligible and the HBV infection itself may be more important. |
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