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KMID : 0376119920190010019
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Medical Journal of the Red Cross Hospital
1992 Volume.19 No. 1 p.19 ~ p.30
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Pathologic Analysis in Renal biopsy of Hemorrhagic Fever with Renal Syndrome and Immunologic Study on Lymphocytic Subpopulation
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Abstract
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Hemorrhagic fever with renal syndome(HFRS) has been recognized since 1913. Then it gained sudden fame, when during the Korean war, many soldiers around the 38 th pararell fell into acute febrile hemorrhagic illness. It is characterized by
generalized
hemorrhage and renal failure. But any pathophysiologic mechanism of HFRS have not been clearly established yet.
To investigate the mechanisism of heavy proteinuria(2~10 gm/day) and tubuloniterstitial nephritis in HFRS, pathologic analysis of 40 patients and immunohistochemical study on lymphocytic subpopulation in the renal biopsied tissue were performed.
@ES The results were as follows:
@EN 1) Two groups of 14 oliguric and 26 non-oliguric patients were studied. This serum creatinine levels were significantly different between the two groups at the levels of 13.37±4.7mg/dl and 7.7±4.1mg/dl, respectively(p<0.01), but 24 hr urine
protein levels were 1859±1565mg/day in non-oliguric patients which was not statistically different(p>0.05).
2) The pathologic findings were interstitial edema, tubular necrosis and mononuclear cell infiltration which were universally found in the all patients of HFRS but there was no histologic difference between the oliguric and non-oliguric
patients.
3) In the jmmunofluorescent study on 20 cases of HFRS, there were 9 cases showing weak positive reaction of IgM, IgG, C3, Clq or C4 deposits in the mesangium or blood vessels and 9 cases displaysing focal IgA or IgM, or C3, C1q or C4 deposits
along the
tubular basement membrane.
4) Electronmicroscopic study showed focal irregularity with fusion of epithelial foot process without electron dense deposits.
Also areas of desquamation of tubular epithelial cells, loss of brush border, and cellular swelling were observed.
5) In the lymphocyte subset study, T cell(UCHL1 positive) were predominantly present and they were mostly T-helper/inducer cells.
With the above findings, it is strongly suggested that one of the mechanisms of renal functional and pathologic derangements in HFRS in induced by T-cells through cellular immunity.
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KEYWORD
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