Korean Journal of Nephrology 1998;17(1):53-65.

한국에서 성인 막증식성 사구체신염의 임상 및 병리학적 특성

정윤철 , 임춘수 , 김정훈 , 박정환 , 안규리 , 한진석 , 김성권 , 이정상 , 이현순 , 김용일

Abstract

We performed a retrospective study to find out the frequency, clinical and pathological characteristics of membranoproliferative glomerulonephritis (MPGN) in Korean adults. Of the total 1,893 adults with biopsyproven glomerulonephritis over the 13-year period from 1979 to 1991 in Seoul National University Hospital, there were 212 cases of MPGN nf whom 22 had primary MPGN and 190 secondary MPGN. Secondary MPGN was composed of 64 cases of hepatitis B virus associated glomerulonephritis(HBV-GN), 121 cases of lupus nephritis(LN) and 5 cases associated with other conditions. Age at diagnosis(median and range in years) was higher in primary MPGN(31, 16-67) and in HBV-GN (39, 16-60) than in LN(28, 16-44)(P<0.05). Male-to- female ratio was 1.2:1 in primary MPGN, 7.5:1 in HBV-GN and 1:13 in LN. At the time of diagnosis, nephrotic syndrome and azotemia were more frequent in primary MPGN(72%, 50%) and in HBV-GN (50%, 42%) than in LN(25%, 15%)(P<0.05). De creases of C3 and CH50 were more common in LN(59%, 77%) than in primary MPGN(24%, 41%) or in HBV-GN(12%, 32%)(P<0.05). On light microscopic exams, tubular atrophy was more frequently observed in primary MPGN(96%) than in HBV-GN(57%) or in LN(69%)(P<0.05). Under immunofluorescence microscopy, mesangial deposition of IgM was more common in HBV-GN (50%) and in LN(59%) than in primary MPGN(6%) (P<0.05). The prognosis was better in LN(13 remission, 15 persistence, 1 end stage) than in primary MPGN(1 remission, 8 persistence, 4 deterioration, 6 end stage) or in HBV-GN(18 persistence, 4 deterioration, 2 end stage)(P<0.05). Conclusively, in Korea considering much higher incidence of secondary MPGN than that of primary MPGN contrary to western countries and the difference in prognosis between the primary and secondary forms, one should consider the possibility of secondary MPGN, especially hepatitis B virus- associated glomerulonephritis and lupus nephritis in adult patients diagnosed as MPGN by kidney biopsy in Korea.