Wagrowska-Danilewicz Małgorzata, Danilewicz Marian
Department of Nephropathology, Medical University of Lódź.
Pol J Pathol. 2007;58(2):87-92.
To establish the role of electron microscopy in the diagnosis of glomerular diseases we reviewed retrospectively 113 renal biopsies. The biopsies were included in this study if tissue was received for light microscopy, immunofluorescence and electron microscopy. The biopsy was assigned to one of the three following categories on the contribution of the ultrastructural findings to the primary diagnosis: essential, important, and not required. Our study revealed that electron microscopy was essential to establish the primary diagnosis in 35 cases (31.0%), was important, but did not alter the preliminary diagnosis in 15 cases (13.3%) and in 63 cases (55.7%) the ultrastructural examination was not needed to confirm the diagnosis. Electron microscopy was essential to create diagnosis in a total of two cases of thin basement membrane disease, in nephropathy in Alport syndrome, in nephropathy in Fabry disease, and was necessary for establishing final diagnosis in 12 cases (85.7%) of minimal lesion. On the basis of electron microscopy it was also possible to establish the precise diagnosis of subtypes in mesangiocapillary glomerulonephritides, describe the stage of membranous glomerulopathy, and find thickening of glomerular basement membrane in the pre-diabetic state. Moreover, ultrastructural examination was helpful to differentiate membranous and mesangiocapillary glomerulonephritis, minimal change nephropathy and early membranous lesions, and distinguish membranous lupus nephritis from idiopathic membranous nephropathy The electron microscopy findings were not of any help in establishing the diagnosis and did not obtain any valuable information in all cases of amyloid nephropathy and IgA nephropathy, as well as in the majority of focal segmental glomerulosclerosis, extracapillary glomerulonephritides, and mesangial proliferative glomerulopathies. In conclusion, the results showed that in 44.3% of glomerulopathies the ultrastructural study provides fundamental or important diagnostic information, and therefore electron microscopy still remains a useful tool in the diagnosis of glomerular diseases.
为确定电子显微镜在肾小球疾病诊断中的作用，我们回顾性分析了113例肾活检病例。若收到的组织用于光镜检查、免疫荧光检查和电子显微镜检查，则将该活检病例纳入本研究。根据超微结构检查结果对初步诊断的贡献，将活检病例分为以下三类之一：必要、重要和非必需。我们的研究表明，电子显微镜对35例（31.0%）病例的初步诊断至关重要，对15例（13.3%）病例重要但未改变初步诊断，63例（55.7%）病例的超微结构检查对确诊并非必需。电子显微镜对两例薄基底膜肾病、阿尔波特综合征肾病、法布里病肾病的诊断至关重要，对12例（85.7%）微小病变病例的最终诊断是必要的。基于电子显微镜还可以明确系膜毛细血管性肾小球肾炎亚型的精确诊断，描述膜性肾小球病的阶段，并发现糖尿病前期状态下肾小球基底膜增厚。此外，超微结构检查有助于鉴别膜性和系膜毛细血管性肾小球肾炎、微小病变肾病和早期膜性病变，并区分膜性狼疮肾炎和特发性膜性肾病。电子显微镜检查结果对所有淀粉样变性肾病和IgA肾病病例，以及大多数局灶节段性肾小球硬化、新月体性肾小球肾炎和系膜增生性肾小球病病例的诊断均无帮助，也未获得任何有价值的信息。总之，结果表明，在44.3%的肾小球病中，超微结构研究提供了重要或关键的诊断信息，因此电子显微镜在肾小球疾病诊断中仍然是一种有用的工具。
