Ueda M, Fujimoto T, Wanibuchi H
Department of Pathology, Osaka City University Medical School, Japan.
Tohoku J Exp Med. 1990 Dec;162(4):309-22. doi: 10.1620/tjem.162.309.
Differences in the pathologic changes of the proximal convoluted tubules, the cortical segments of the thick ascending limbs of the loops of Henle, and the distal convoluted tubules in the end-stage kidneys with chronic glomerulonephritis were studied by means of both light and electron microscopy. Kidneys with chronic glomerulonephritis were obtained from 8 non-dialyzed patients at autopsy and 9 dialyzed patients at the time of nephrectomy prior to renal transplantation. Epithelial cell clusters with clear cytoplasm, decreases in the luminal and outer diameters of the tubules, and thin basement membranes were observed in both the non-dialyzed and dialyzed kidneys to varying degrees. The epithelial cell clusters were more extensive and distinct in kidneys from patients with a long history of chronic glomerulonephritis and/or long-term hemodialysis. Electron microscopy of the epithelial cell clusters revealed the absence or narrowing of lumens and luminal surfaces that were smooth except for a few short microvilli. Observation of serial sections showed that these epithelial cell clusters were derived from the distal convoluted tubules belonging to obsolescent glomeruli. This form of tubular change is quite different from the well-known atrophy of the proximal convoluted tubules belonging to obsolescent glomeruli in chronic glomerulonephritis.
采用光学显微镜和电子显微镜对慢性肾小球肾炎终末期肾脏近曲小管、髓袢升支粗段皮质部及远曲小管的病理变化差异进行了研究。慢性肾小球肾炎患者的肾脏取自8例未透析患者的尸检标本以及9例肾移植术前肾切除时的透析患者。在未透析和透析的肾脏中均不同程度地观察到细胞质清晰的上皮细胞簇、肾小管管腔和外径减小以及基底膜变薄。上皮细胞簇在慢性肾小球肾炎病史长和/或长期血液透析患者的肾脏中更为广泛和明显。上皮细胞簇的电子显微镜检查显示管腔缺失或狭窄，管腔表面除少数短微绒毛外较为光滑。连续切片观察表明，这些上皮细胞簇来源于废弃肾小球所属的远曲小管。这种肾小管变化形式与慢性肾小球肾炎中废弃肾小球所属近曲小管的众所周知的萎缩截然不同。
