Amer. J. Path., 46 : 387-401, 1965. 6) Sherlock, S. & Scheuer, P. J.: The presentation and diagnosis of 100 patients with primary biliary 8) Kimmelstiel, P.: Diabetic nephropathy. In Bec 1968, p 462. 9) Jones, W. A. et al.: The renal glomerulus in cirrhosis of the liver. Amer. J. Path., 404, 1961. 39 : 393-2) Bloodworth, J. M. B. et al, m "Cirrhotic glomerulosclerosis", a renal lesion associated with hepatic cirrhosis. Lab. Invest., 8 : 962-978, 1959. 1975. 4) Rubin, E, et al.: Primary biliary cirrhosis, chronic non-suppurative destructive cholangitis. cirrhosis. New Engl. J. Med., 289 : 674-678, 1973. 7) Ingbar, S. H. & Woeber, K. A.: Diseases of the thyroid. In Wintrobe, M. M. et al. (Eds) Harrison's Principles of Internal Medicine, 7 th ed., Tokyo : McGill-Hill, Kogakusha, Ltd., 1974, p484. ker, E. L. (Ed) Structural basis of renal disease, New York : Hoeber Med. Div., Harper and Row, 10) Fisher, E. R. & Hellstrom, H. R.: The membranous and prolif erative glomerulonephritis of hepatic cirrhosis. Amer. J. Clin. Path., 32 : 48-55, 1959. 11) Fisher, E. R. & Perez-Stable, E.: Cirrhotic(hepatic) lobular glomerulonephritis, correlation of ultrastructure and clinical features. Amer. J. Path, 52:869-889, 1968. 12) Sakaguchi, H. et al.: Hepatic glomerulosclerosis, an electron microscopic study of renal biopsies in liver diseases. Lab. Invest., 14 : 533-545, 1965. 13) Salomon, M. I., Sakaguchi, H., et al.: Renal lesions in hepatic disease, a study based on kidney biopsies. Arch. intern. Med., 115 : 704-709, 1965. 14) Germuth, F. G. & Rodrigez, E.: Immunopathology of the renal glomerulus, immune complex deposit and anti-basement membrane disease. Boston : Little, Brown, 1973. 15) Walker, J. G. et al.: Serological tests in diagnosis of primary biliary cirrhosis. Lancet, 1 : 827-831, 1965. 16) Koffler, D. & Friedman, A. H.: Localization of immunoglobulins in chronic thyroiditis. Lab. In-

vest., 13 : 239-245, 1964. 17) Merril, J. P.: Glomerulonephritis. New Engl. J. Med., 290: 313-319, 1974. 18) Whittingham, S. et al.: Autoimmune hepatitis, immunofluorescence reaction with cytoplasm of smooth muscle and renal glomerular cells. Lancet, 1 1333-1335, 1966. 19) Hayman, L. R. et al.: Immunoglobulin-A distribution in glomerular disease : analysis of immunofluorescene localization and pathogenetic significance. Kidney Internat., 3 : 397-408, 1973. 20) Lowance, D. C. et al.: Immunoglobulin A (Ig A) associated glomerulonephritis. Kidney Internat. 3: 167-176, 1973. Glomerular changes in a case with primary biliary cirrhosis, Hashimoto's thyroiditis and Sjogren syndrome, Tanenao Eto, Kaoru Onoyama, Satoru Fujimi, Yoshitaka Yamamoto, Masayoshi Yamanaka, Teruo Omae Second Department o f Internal Medicine, Faculty o f Medicine, Kyushu University, (Director : Prof. T. Omae), Haruka Sasaki, Makoto Okumura First Department of Internal Medicine, School of Medicine, Fukuoka University, (Director : Prof. M. Okumura). Kidney tissues obtained by renal biopsy from a patient with primary biliary cirrhosis, associated with Hashimoto's thyroiditis, Sjogren's syndrome and persistent proteinuria were studied by light microscopy, immunofluorescent technique and electron microscopy. On light microscopy, the slight changes were observed in the renal glomerulus. The changes consisted of slight increase in mesangial PAS positive material. The mesangial cells were not increased. Immunof luorescent microscopy showed fine granular deposition of Ig A in mesangial areas and focally in capillary loops. However, complement (C3) was not found within the glomerulus. On electron microscopy, fine granular, electron dense deposits and black particles surrounded by electron lucent zone appeared within mesangial matrix and in the subendothelial space of the capillary walls. The electron dense deposits were not differentiated from so-called immune deposit. Interposition of the processes of mesangial cells between the endothelium and the basement membrane was frequently observed in paramesangial regions. These findings in the renal glomerulus were compatible with those of hepatic glomerulosclerosis or hepatic lobular glomerulonephritis

168 橋本 甲 状腺 炎,Sjogren症 候 群 を 伴な つ た 原 発性 胆 汁 性 肝硬 変 症 の腎 生 検 所 見 (42)

日腎 誌 第XVII巻 第3号1975 江藤 胤尚他7名169

170 橋 本 甲 状 腺 炎,Sjogren症 候 群 を 伴 な つ た原 発性 胆汁 性 肝 硬 変性 の 腎 生検 所 見 (44)