Abstract
One case of membranous glomerulonephritis (MGN) associated with primary diabetes mellitus has been followed for more than 5 years. Peripheral blood lymphocyte, lymphocytotoxins, immune complexes, and EB virus antibodies were serially assayed. These studies demonstrated that the patient had 50% of B cells (C3 receptor, Fc receptor and/or IF positive cell), 3% of Tγ cells, positive lymphocytotoxins, increased lymphocyte blastogenesis with decreased Ig secretion less than 50% of control lymphocytes, and VCA (IgG) 320×, VCA (IgM) <10×, EA. DR (IgG) 20×, and EBNA<10× that suggested latent EB virus infection. Renal histology was the typical MGN in addition to diffuse lesion of diabetic nephropathy diagnosed by LM, IF, and EM. However, no positive immunofluorescent findings for insulin, anti-insulin antibody, and EB virus antigens were found. During the long term observation, the nephrotic syndrome disappeared spontaneously and it was paralleled wih the association of Tγ cell increment to 17%, raised lymphocytotoxins to 50% accompanied by positive anti-Tγ cell antibody, and increased EB virus antibodies such as VCA (IgG) to 640×, VCA (IgM) to<10×, EA. DR (IgG) to 80×, and EBNA to 40×, which were considered as the reactivation of EB virus. The possibie pathogenetic relationships between diabetes mellitus, MGN, and EB virus infection were discussed.
