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In his election to the presidency in 1932, Franklin D. Roosevelt

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先程の3ステップの見方をより具体的に書くと,①どこに→沈着の局在(糸球体のどの部分に),②どのように→沈着の形態(顆粒状,線状など),③何が→沈着の質(免疫グロプリンや補体の種類)これらの用語を組み合わせて書きます。まず①②の組み合わせによって,疾患ごとにある程度のパターンが存在します。1.①どこに&②どのように沈着しているか?沈着の局在と形態まず,糸球体の中で免疫複合体の沈着が起こりうる部位は"メサンギウム"と"糸球体係蹄"の2部位に大別され,さらに電子顕微鏡レベルで細分化すると下記の5カ所があります。メサンギウム沈着→メサンギウム領域,パラメサンギウム領域のどちらか?糸球体係蹄沈着→上皮下,基底膜内,内皮下のどこか?.実際にIFの所見を記述する場合は,大きく分けて「メサンギウム沈着なのか」もしくは「係蹄壁沈着なのか」の2種類です。まずこの両者を見分けるには,「沈着によって糸球体の輪郭が追えるかどうか」が1つの目安になります。糸球体は毛細血管の集合体で,1つの球体と見立てると,構造学的にはメサンギウムはそれら毛細血管を束ねる骨格であり,表面からは一層内側に存在しています。一方,毛細血管係蹄は"球"の表面を形成しており,つまり係蹄は糸球体の輪郭そのものを形成するため係蹄沈着は文字通りIF写真でも糸球体の輪郭が追えるような沈着様式をとります,この見方で感覚的にメサンギウム沈着なのか係蹄沈着なのかがわかります。

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