抄録
Various clinical findings and histologic changes were seen in patients with nephrotic syndrome. According to the light microscopic glomerular changes, (refered to the findings of the electromicroscopy and the immunofiuorescent study), 71 cases of the nephrotic syndrome resulting from glomerulonephritis were classified into 6 groups. In the group I, glomeruli showed no remarkable changes or very slight cellular proliferation. In the group II, slight and partial thickening of the basement membrane were present in almost all of the glomeruli. In the group III, most of the glomeruli showed marked, diffuse thickening of the basement membrane (Membranous glomerulonephritis). In the group IV, most of the glomeruli showed proliferation of mesangial and endothelial cell with glomerular lesions belonging to group II (Proliferative glomerulonephritis). In the ;group V, biopsy specimens showed lobulation of the glomerular tufts resulting from increased mesangial cells and partially thickend basement membrane (Lobular glomerulonephritis). In the group VI, biopsy specimens showed hyalinisation and sclerosis of the glomerular tufts with glomerular changes belonging to group II, IV, and V (Chronic sclerosing glomerulonephritis). An attempt was made to clarify the relationship between the various clinical and histologic findings and effects of steroid therapy on the patients.The results were as follows:(1) The relationship between various clinical findings and effects of steroid therapy. In the group with more increased nephritic changes in the nephrotic syndrome, effects of steroid therapy decreased, and the degrees of proteinuria, hypoproteinemia and hypercholesteremia, characteristic findings of the nephrotic syndrome, were not related to the effects of steroid therapy, but the cases with low amount of serum albumin had a tendency to show good effects of therapy. At the time of a high degree of edemaa it was often difficult to estimate the effects of steroid therapy from the value of NPN, PSP and renal clearance but in the cases with slight histologic changes these value recovered to the extent of normal value by the steroid therapy.(2) The relationship between histologic changes and clinical findings. In the group with slight histologic changes, patients were generally younger than in other groups and duration after onset was shorter on the almost cases, and the cases with hypertension and hematuria were few. The cases in the group III had a lot of urinary protein, and in the group with slight histologic changes amount of serum albumin were smaller than in other groups, but in the group with severe histologic changes amount of serum albumin had a tendency to increase. Renal function at the time of a high degree of edema did not reflect the severity of histologic changes.(3) The correlation between histologic changes and effects of steroid therapy. In the group I and II with few or slight histologic changes, all cases were more responsible to steroid. therapy but in the group III all were less responsible. In the group IV, about one half of cases were responsible to steroid therapy and others not responsible. When examined in detial, however, according to the severity of histologic changes the difference of the therapeuiic effec was seen also among the cases of this group and in the cases with severe histologie changes therapeutic effects were hardly observed. Therefore, on the determination of the effect of steroid therapy histologic findings are at the present moment a valueable procedure and at a considerably high percentage effects of steroid therapy can be estimated by the histology. Relapse was seen in all groups. However, relapse in the group I and II was improved by the therapy but in the group IV improvement after relapse was not easily obtained.(4) The glomerular histology after the steroid therapy was essentially identical to the histology observed. before the treatment.(5) The relationship between the
