高度の問質病変を示した非ネフローゼ型巣状糸球体硬化症の1例

Abstract

A 24-year-old man with primary focal segmental glomerulosclerosis (FSGS) with severe tubulo-interstitial change is reported. He was first noticed to have proteinuria on an annual medical checkup at his school in June, 1986. He was referred to our hospital for evaluation of proteinuria. The laboratory tests revealed moderate proteinuria (1.8 g/day) and normal renal function. The renal biopsy showed mild mesan- gial proliferative glomerulonephritis with mild tubulo-interstitial change. As his renal function gradually declined, the second biopsy was performed in November, 1990. Tubulo -interstitial change got worse compared to the first biopsy. Because creatinine clearance was gradually decreasing (57ml/min in July 1993), the third biopsy was performed. The biopsy specimen contained 12 glomeruli, of which only one showed segmental sclerosis. Then a diagnosis of idiopathic focal segmental glomerulosclerosis was made 7 years after manifestation of proteinuria. This case suggests that in FSGS tubulo-interstitial change advances more conspicuously than glomeruli do, and that it takes long duration to make a diagnosis.