Akikusa B, Irabu N, Matsumura R, Tsuchida H
Department of Pathology, School of Medicine, Chiba University, Japan.
Am J Kidney Dis. 1990 Nov;16(5):481-6. doi: 10.1016/s0272-6386(12)80064-3.
Tubulointerstitial alterations were studied in 18 biopsy cases of systemic vasculitis. To evaluate the changes more objectively, two indexes, the number of interstitial inflammatory cells and tubulitis percentage, were used. The group means of both of these indexes were statistically higher than those of the autopsy control group, while 14 of the cases (77.8%) showed a significant difference (P less than 0.01) between individual means and the control group means. On the other hand, tubulointerstitial changes in systemic vasculitis seemed to be less prominent than drug-induced tubulointerstitial nephritis (TIN) according to these indexes. However, comparing these indexes with those of drug-induced TIN, six cases (33.3%) of systemic angiitis could be regarded as having developed pathologic changes similar to TIN. Statistical difference was not shown in the indexes between those patients with histologic evidence of necrotizing angiitis and those without it. Clinically, urinary N-acetyl-beta-D-glucosaminidase (NAG) was abnormally high in all three examined cases, reflecting the damage of renal tubular epithelial cells. Not only the vascular and glomerular lesions, but also tubulointerstitial changes, should be evaluated in the renal biopsy specimen of systemic vasculitis.
对18例系统性血管炎的活检病例进行了肾小管间质改变的研究。为了更客观地评估这些变化，使用了两个指标，即间质炎症细胞数量和肾小管炎百分比。这两个指标的组均值在统计学上均高于尸检对照组，而14例病例（77.8%）的个体均值与对照组均值之间存在显著差异（P<0.01）。另一方面，根据这些指标，系统性血管炎的肾小管间质改变似乎不如药物性肾小管间质性肾炎（TIN）明显。然而，将这些指标与药物性TIN的指标进行比较时，6例（33.3%）系统性血管炎病例可被视为发生了与TIN相似的病理改变。有坏死性血管炎组织学证据的患者与无此证据的患者在这些指标上未显示出统计学差异。临床上，所有3例受检病例的尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）均异常升高，反映了肾小管上皮细胞的损伤。在系统性血管炎的肾活检标本中，不仅应评估血管和肾小球病变，还应评估肾小管间质改变。
