Shao Youzhi, Connors Bret A, Evan Andrew P, Willis Lynn R, Lifshitz David A, Lingeman James E
Department of Histology, Jinzhou Medical College, Jinzhou, Liaoning Province, People's Republic of China.
Anat Rec A Discov Mol Cell Evol Biol. 2003 Nov;275(1):979-89. doi: 10.1002/ar.a.10115.
While shock wave lithotripsy (SWL) is known to cause significant damage to the kidney, little is known about the initial injury to cells along the nephron. In this study, one kidney in each of six juvenile pigs (6-7 weeks old) was treated with 1,000 shock waves (at 24 kV) directed at a lower pole calyx with an unmodified HM-3 lithotripter. Three pigs were utilized as sham-controls. Kidneys were fixed by vascular perfusion immediately after SWL or sham-SWL. Three of the treated kidneys were used to quantitate lesion size. Cortical and medullary samples for light (LM) and transmission electron microscopy (TEM) were taken from the focal zone for the shock waves (F2), the contralateral kidney, and the kidneys of sham-SWL pigs. Because preservation of the tissue occurred within minutes of SWL, the initial injury caused by the shock waves could be separated from secondary changes. No tissue damage was observed in contralateral sham-SWL kidneys, but treated kidneys showed signs of injury, with a lesion of 0.2% +/- 0.1% of renal volume. Intraparenchymal hemorrhage and injury to tubules was found at F2 in both the cortex and medulla of SWL-treated kidneys. Tubular injury was always associated with intraparenchymal bleeding, and the range of tissue injury included total destruction of tubules, focal cellular fragmentation, necrosis, cell vacuolization, and membrane blebbing. The initial injury caused by SWL was cellular fragmentation and necrosis. Cellular vacuolization, membrane blebbing, and disorganization of apical brush borders appear to be secondary changes related to hypoxia.
虽然已知冲击波碎石术（SWL）会对肾脏造成严重损害，但对于沿肾单位的细胞初始损伤却知之甚少。在本研究中，使用未改良的HM - 3碎石机，对6只幼年猪（6 - 7周龄）的每只猪的一侧肾脏，朝着下极肾盏施加1000次冲击波（24 kV）。3只猪用作假手术对照。在SWL或假手术 - SWL后立即通过血管灌注固定肾脏。对3只接受治疗的肾脏进行损伤大小定量。从冲击波聚焦区（F2）、对侧肾脏以及假手术 - SWL猪的肾脏中，采集用于光镜（LM）和透射电子显微镜（TEM）检查的皮质和髓质样本。由于在SWL后数分钟内组织得以保存，因此可以将冲击波引起的初始损伤与继发变化区分开来。在对侧假手术 - SWL肾脏中未观察到组织损伤，但接受治疗的肾脏显示出损伤迹象，损伤体积占肾体积的0.2%±0.1%。在SWL治疗的肾脏的皮质和髓质的F2处均发现实质内出血和肾小管损伤。肾小管损伤总是与实质内出血相关，组织损伤范围包括肾小管完全破坏、局灶性细胞破碎、坏死、细胞空泡化和膜泡形成。SWL引起的初始损伤是细胞破碎和坏死。细胞空泡化、膜泡形成以及顶端刷状缘的紊乱似乎是与缺氧相关的继发变化。
