신증후 출혈열 환자의 신장조직 병리소견 및 단핵구침윤에 대한 면역학적 성상에 관한 연구 = Pathologic analysis in renal biopsy of hemorrhagic fever with renal syndrome and immunologic study on lymphocytic subpopulation

다국어 초록 (Multilingual Abstract)

Hemorrhagic fever with renal syndrome (HFRS ) has been recognized since 1913. Then it gained sudden fame, when during the Korean war, many soldiers around the 38th pararell fell into acute febrile hemorrhagic illness. It is characterized by generalized hemorrhage and renal failure. But any pathophysiologic mechanisms of HFRS have not been clearly established yet.
To investigate the mechanism of heavy proteinuria (2-10gm/day) and tubulointerstitial nephritis in HFHS, pathologic analysis of 40 patients and immunohistochemical study on lymphocytic subpopulation in the renal biopsied tissue were performed.
The results were as follows :
1. Two groups of 14 oliguric and 26 non-oliguric patients were studied. The 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 24hr urine protein levels were 1859 ±1565mg /day in oliguric patients and 1799 ± 2219mg/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 immunofluorescent study on 20 cases of HFRS, there were 9 cases showing weak positive reaction for IgM, IgG, C3, Clq or C4 deposits in the mesangium or blood vessels and 9 cases displaying focal IgA or IgM, or C3, Clq or C4 deposits along the tubular basement membrane.
The remaining 5 cases were entirely negative for all immunoglobulins.
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 is induced by T-cells through cellular immunity.