每日一题_2023.08.22

A 13-year-old boy is brought to the emergency department with periorbital edema, hypertension, and tea-colored urine. His parents say that he had a sore throat about three weeks ago. Urinalysis shows RBCs with casts. A positive antistreptolysin O titer and decreased levels of complement are also noted. What findings would be expected in this patient’s glomeruli?

一名13岁男孩因眶周水肿、高血压和茶色尿液被送到急诊科。他的父母说大约三周前他喉咙痛。尿液分析显示红细胞伴管型。还观察到抗链球菌溶血素O滴度阳性和补体水平降低。该患者的肾小球预期会出现什么结果?

(A) Granular subendothelial deposits 颗粒状内皮下沉积

(B) Linear subendothelial pattern 线状内皮下模式

(C) Mesangial deposits系膜沉积

(D) Subepithelial humps上皮下隆起

答案解析：

急性链球菌感染后肾小球肾炎是一种最常见于儿童的自身免疫性疾病。光镜下，肾小球增大，细胞增多，有中性粒细胞和上皮下免疫复合物沉积，描述为“凹凸不平”。电镜下可见肾小球上皮下大量不规则沉积。这种情况通常在链球菌感染后几周出现，伴有外周和眶周水肿、尿色深和蛋白尿。这些症状是由循环抗链球菌抗体-抗原复合物沉积在肾小球基底膜，导致补体激活和肾小球损伤引起的。典型的发现是尿液中的红细胞和铸型(导致特征性茶色尿液)、ASO滴度阳性和补体水平降低。

正确答案:D