Diusiubaev A A, Shalashov V A
Urologiia. 2007 Nov-Dec(6):29-31.
The aim of the study was to investigate the role of thin needle aspiration biopsy (TNAB) of the kidneys in differential diagnosis of serous and purulent pyelonephritis. TNAB of the kidneys under ultrasound control was made in 126 patients with acute pyelonephritis (AP). Renal aspirate and peripheral blood smears were stained according to May-Grunvald-Gimze. The number of immature and mature neutrophils, lymphocytes, eosinophils per 100 blood cells was counted as well as the increment of these cells in peripheral blood. Cytological tests of aspiration biopsy of the kidneys and peripheral blood have demonstrated that purulent-destructive forms of AP are characterized by a significant rise in the count of immature and mature neutrophils (by 15.7 +/- 1.2%, p < 0.001 and 16.8 +/- 3.2%, p < 0.001, respectively), deficiency of lymphocytes and monocytes, impairment of tubular cells in the renal biopsy. Cytological signs of purulent pyelonephritis were detected in 86 (68.2%) of 126 patients. This diagnosis was confirmed intraoperatively and histologically. No increment in the count of the above cells in puncture samples was found in 40 (31.8%) patients, so the diagnosis of purulent pyelonephritis in them was rejected. False positive results were obtained in 2 patients. Minor invasiveness, high informative value make TNAB of the kidney a useful tool in urgent diagnosis of acute pyelonephritis forms. In unclear situations this method should be used after 24 hours since the start of ineffective treatment.
本研究旨在探讨肾细针穿刺活检（TNAB）在浆液性和脓性肾盂肾炎鉴别诊断中的作用。对126例急性肾盂肾炎（AP）患者在超声引导下进行了肾TNAB。肾穿刺抽吸物和外周血涂片按May-Grunvald-Gimze法染色。计算每100个血细胞中未成熟和成熟中性粒细胞、淋巴细胞、嗜酸性粒细胞的数量以及外周血中这些细胞的增加量。肾穿刺活检和外周血的细胞学检查表明，AP的脓性破坏形式的特征是未成熟和成熟中性粒细胞计数显著升高（分别升高15.7±1.2%，p<0.001和16.8±3.2%，p<0.001），淋巴细胞和单核细胞缺乏，肾活检中肾小管细胞受损。126例患者中有86例（68.2%）检测到脓性肾盂肾炎的细胞学征象。术中及组织学检查证实了这一诊断。40例（31.8%）患者穿刺样本中上述细胞计数未增加，因此排除了脓性肾盂肾炎的诊断。2例患者出现假阳性结果。肾TNAB微创性小、信息价值高，是急性肾盂肾炎各型紧急诊断的有用工具。在情况不明时，应在无效治疗开始24小时后使用该方法。
