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Relationship between glomerular lesions, serum creatinine and interstitial volume in membrano-proliferative glomerulonephritis

Beziehung zwischen glomerulären Veränderungen, Serum-Kreatininspiegel und relativem Interstitiumvolumen bei membranoproliferativer Glomerulonephritis

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Zusammenfassung

An 33 Patienten mit membranoproliferativer GN verschiedener Schweregrade konnte gezeigt werden, daß keine sicheren Beziehungen zwischen Ausmaß der glomerulären Veränderungen und dem Serum-Kreatininspiegel bestehen.

Andererseits zeigen morphometrische Untersuchungen signifikante positive Korrelationen zwischen dem relativen Interstitiumvolumen und dem Serum-Kreatininspiegel. Der Kurvenverlauf entspricht am ehesten einer Exponentialfunktion (y=0,563·e 0,049x,r=+0,87,p<0,0001).

Bei der membranoproliferativen GN, die allgemein als rein glomeruläre Erkrankung angesehen wird, müssen auch Veränderungen im Interstitium als eine Ursache der Nierensuffizienz in Betracht gezogen werden. Glomeruläre Schäden allein reichen zur Erklärung der beeinträchtigten Nierenfunktion nicht aus.

Der pathophysiologische Mechanismus, der über eine — möglicherweise immunologisch bedingte — Verbreiterung des Niereninterstitiums zur Niereninsuffizienz führt, muß noch geklärt werden.

Summary

Morphometric investigations in 33 patients suffering from membranoproliferative glomerulonephritis at different grades of glomerular involvement showed that there is no certain relationship between the severity of glomerular lesions and the serum creatinine level.

On the other hand there is a significant positive correlation between the relative interstitial volume and the level of serum creatinine. The best congruence (r=+0,87,p<0.0001) showed an exponential functiony=0.563·e 0.049x.

We therefore conclud that in membranoproliferative glomerulonephritis which is generally considered to be a glomerular disease, interstitial changes have to be taken into account as a cause of renal insufficiency. Glomerular lesions alone cannot explain the functional impairment.

The pathophysiologic factors concerning increased interstitial volume as a cause of renal insufficiency — probably immunologic in origin — are yet to be completely clarified.

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Authors and Affiliations

  1. Institute of Pathology, University of Tübingen, Germany

    H. Fischbach, S. Mackensen, K. -E. Grund, A. Kellner & A. Bohle

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  1. H. Fischbach
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  2. S. Mackensen
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  3. K. -E. Grund
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  4. A. Kellner
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  5. A. Bohle
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Fischbach, H., Mackensen, S., Grund, K.E. et al. Relationship between glomerular lesions, serum creatinine and interstitial volume in membrano-proliferative glomerulonephritis. Klin Wochenschr 55, 603–608 (1977). https://doi.org/10.1007/BF01490515

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  • DOI: https://doi.org/10.1007/BF01490515

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