Thiele J, Kühn K, Zobl H, Krull P
Beitr Pathol. 1976 May;157(4):349-66.
In paraproteinemia, especially in multiple myeloma, the origin and morphology of lesions in the kidneys still remain controversial. In many studies mostly of tissue obtained post mortem and examined with light microscopy, a discrepancy between impairment of renal function and minimal pathomorphological findings is often striking. The few studies done with the electron microscope up to now present a wide variety of morphological findings probably due to the different stages of kidney lesions examined, generally in patients with renal insufficiency and nephrotic syndrome. We have therefore tested the question whether early lesions are detectable in the nephron of patients with paraproteinemia who do not show any impairment of renal function.
Kidney biopsies were obtained from 8 patients with an average age of 58 years. 6 had multiple myeloma (3 IgG-, I IgA-, 2 Bence-Jones plasmacytoma), 1 Waldenström's disease and 1 an idiopathic paraproteinemia. Confirmation of the diagnoses was obtained by immunoelectrophoresis, bone marrow biopsy, and sternal puncture. In all cases creatinine clearance was normal and proteinuria was not increased substantially even in patients with a slight Bence-Jones-proteinuria. For electron microscopy small pieces from the renal biopsies were fixed in aldehydes followed by osmium tetroxide and embedded in Epon. The thin sections were stained with uranyl acetate followed by lead citrate...
在副蛋白血症中，尤其是在多发性骨髓瘤中，肾脏病变的起源和形态仍存在争议。在许多主要对尸检获得的组织进行光学显微镜检查的研究中，肾功能损害与微小病理形态学发现之间的差异往往很显著。迄今为止，少数使用电子显微镜进行的研究呈现出各种各样的形态学发现，这可能是由于所检查的肾脏病变处于不同阶段，这些研究通常针对肾功能不全和肾病综合征患者。因此，我们探讨了在肾功能未出现任何损害的副蛋白血症患者的肾单位中是否能检测到早期病变这一问题。
从8名平均年龄为58岁的患者身上获取肾脏活检组织。其中6例患有多发性骨髓瘤（3例IgG型、1例IgA型、2例本-周蛋白浆细胞瘤），1例患有华氏巨球蛋白血症，1例患有特发性副蛋白血症。通过免疫电泳、骨髓活检和胸骨穿刺确诊。在所有病例中，肌酐清除率均正常，即使是轻度本-周蛋白尿患者，蛋白尿也没有显著增加。对于电子显微镜检查，将肾脏活检组织的小块用醛类固定，然后用四氧化锇处理，再包埋在环氧树脂中。超薄切片先用醋酸铀染色，然后用柠檬酸铅染色……
