Læknablaðið - 01.12.1979, Blaðsíða 10

278
LÆKNABLAÐIÐ
meingerð grunnhimnubólgu í nýrnahnykli.
Það hefur verið talið,22 31 að gull hagi sér
sem væki eða „hapten“, sem komi af stað
komplímentkerfinu, er leiði til myndunar
„immune komplexa“ og síðan grunnhimnu-
bólgu í nýrnahnyklum. Vefjarannsóknir á
sjúklingi okkar staðfestir ekki þessa tegund
meingerðar, þar sem gull fannst ekki í
grunnhimnu nýrnahnykla með röntgen
málmgreiningu.38 Aðrir hafa með líkum að-
ferðum heldur ekki sýnt fram á gull í
grunnhimnu hjá þessum sjúklingum.40 4]
Silverberg31 telur að gull leiði til skemmda
á grunnhimnu nýrnahnykils, og væki gegn
grunnhimnunni myndist með myndun
sjálfgrunnhimnusjúkdóms (anti-GBM dis-
ease). Þar sem „immuno“ smásjárskoðun á
nýrnahnyklum þessara sjúklinga sýnir
línulaga litun á móte-fnum í grunnhimnu,
en við og aðrir höfundar,10 32 30 40 41 höfum
ekki séð þessa tegund litunar á „immuno"
mieroscopiu, er því þessi meingerð úti-
lokuð.
Hugsanlegt er, að gull veki upp væki í
öðrum vefjum líkamans, með myndun upp-
leysanlegra „immune komplexa" og mynd-
un grunnhimnu nýrnahnykilsbólgu. Þetta
er ekki hægt að útiloka.28
SUMMARY
We have described a patient who developed
nephrotic syndrome with changes of an im-
mune complex membraneous nephropathy fol-
lowing gold theraphy. When gold salt therapy
was discontinued, the clinical nephrotic syn-
drome disappeared and the renal lesion re-
gressed histologically. These observations are
consistent with the notion that gold nephro-
pathy is an autologous immune complex glome-
rulopathy induced by the release of renal tu-
bular epithelial cell antigen.
HEIMILDIR
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