慢性関節リウマチにおける腎病変の研究 第2編 腎病変を合併した慢性関節リウマチ患者の腎生検による検討

Renal biopsies were performed on seven patients with rheumatoid arthritis (RA) and proteinuria. The material was examined by light and immunofluorescent microscopy. Two of the biopsy specimens were examined by electron microscopy. Membranous nephropathy was found in six of the seven specimens. Brilliant, fine granular fluorescence with IgG was present along the glomerular capillary loops under immunofluorescent microscopy. These findings suggested that these renal disorders were due to an immune complex mechanism. The proteinuria of five patients indicated that the membranous nephropathy occurred following D-penicillamine treatment or chrysotherapy. In one patient, there was no evidence of a relationship between D-penicillamine and proteinuria from her history. The remaining patient had a mild cell proliferative glomerulonephritis under light microscopy. Fluorescence was not found under immunofluorescent microscopy. For this reason, it seemed that the renal disorder was not caused by D-penicillamine, althoug her history showed that D-penicillamine brought on proteinuria. These findings suggested that renal biopsy is desirable in patients with long term proteinuria, when the proteinuria is clearly caused by D-penicillamine or gold salts. Furthermore, it seemed that long term proteinuria due to D-penicillamine, was probably caused by an immunological mechanism. The seven patients showed no evidence of secondary amyloidosis due to RA.