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表 1 Frequency and course of glomerular lesions associated with Preeclampsia

表 1 Frequency and course of glomerular lesions associated with Preeclampsia. Lesion Frequency Course. Endotheliosis Invariable Reversible over weeks to months

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表 1 Frequency and course of glomerular lesions associated with Preeclampsia

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  1. 表1 Frequency and course of glomerular lesions associated with Preeclampsia Lesion Frequency Course Endotheliosis Invariable Reversible over weeks to months Foam cells Rare peripartum, Resolve more frequent postpartum Subendothelial Frequent peripartum EM deposits resolve over first deposits week, Ig staining resolve over 2-3 months GBM reduplication More common in severe Usually resolve rapidly, may disease persist for months Fibrin or related Rare by light microscopy; Resolve over weeks products frequent by EM and IF Focal segmental Variable Not clinically progressive glomerulosclerosis 35%(7/20, ref. 108) 45%(19/42, ref.146) 71%(13/19, ref.145) Heptinstall’s Pathlogy of the Kidney Sixth Edition p784, Lippincott Williams & Wilkins, Philaderphia. 2007.

  2. 図1 Endotheliosis（内皮細胞の腫大） & Foam cell Foam cell 内皮細胞の腫大で係蹄腔がよく見えない

  3. 図2 Subendothelial deposits 内皮下のElectron-dense deposits(EDD) 内皮下は脂質やその他の血漿成分 などで著明に拡大している 内皮下のEDDはfibrillaryな 構造を示す。granularなこともある。

  4. 図3 GBM reduplication 係蹄的の二重化

  5. 図4 Fibrin or related products IF,Fibrinogen

  6. 図5 Focal segmental glomerulosclerosis

  7. 解説 • いわゆる妊娠腎はWHOの分類ではNephropathy of Toxemia of Pregnancy(Preeclamptic Nephropathy）と記載されている。 2.　この腎病変の主体は妊娠高血圧症（旧妊娠中毒）の際の血中の存在する何らかのtoxinによる内皮障害でEndotheliosisが特に重要である。臨床情報がないと一見、管内増殖性腎炎のように見えるが、外来系の炎症細胞がない点で区別可能である。 3.　ネフローゼ症候群を呈する症例では、 Focal segmental glomerulosclerosis（FGS）を示した時は原発性のものとの鑑別が必要であるが、原発性のFGSでは糸球体に上記のEndotheliosisの所見が認められないことと、間質の線維化を伴う症例が多い点が鑑別となる 。また臨床的には原発性のFGSでは出産後もネフローゼ状態がずっと続く点が異なる。

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