TUBULAR AND INTERSTITIAL LESIONS AND MONONUCLEAR CELL INFILTRATION INPRIMARY FORMS OF GLOMERULONEPHRITIS

In the present study of 246 patients with primary forms of glomerulone phritis (GN) we investigated their tubular and interstitial changes, e specially mononuclear cell infiltration and optical microscopy, and co mpared this finding with the outcome of the disease (5-year survival r ate). Only first biopsies were analyzed in order to detect early tubul ointerstitial changes which occur together with the glomerular changes . Different degrees of the lesions of tubules and interstitium were pr esent in different forms of GN. Mononuclear cell infiltration was pres ent in 100% of the patients with crescentic, in 90.9% in focal scleros ing, in 89% in membranoproliferative, and in 76.4% of patients with ch ronic diffuse GN. Less than 50% of the other patients showed infiltrat ion. Using monoclonal antibodies it was demonstrated that mononuclear cell infiltrates mainly consisted of T and T4 cells. Interstitial edem a was expressed in the same forms of GN and in similar proportions. In terstitial fibrosis was found only in patients with: focal sclerosing GN (13.7%), IgA GN (4.1%), membranoproliferative GN (31.4%), chronic d iffuse GN (23%), and crescentic GN (27.7%). Tubular atrophic changes w ere again dominantly present in: crescentic GN (94.2%), focal sclerosi ng GN (77.8%), chronic diffuse GN (76.4%), and membranoproliferative G N (68.4%). Patients with severe tubulointerstitial changes together wi th the glomerular changes had a low 5-year survival rate of renal func tion.