Martínez Miguel A, Bárcena Carmen, Ramchandani Bunty, Rodriguez Gil Yolanda, Morales José M
Servicio de Anatomía Patológica , Hospital Universitario 12 de Octubre, Madrid , Spain .
Ultrastruct Pathol. 2013 Dec;37(6):379-85. doi: 10.3109/01913123.2013.810682. Epub 2013 Jul 22.
Membranous glomerulopathy is a common complication of renal allograft. However, its incidence and prognosis are not well defined, because an undetermined number of them pass undiagnosed under the generic epigraph of chronic allograft nephropathy.
To assess the diagnostic refinement supplied by electron microscopy to conventional light and immunofluorescence procedures the authors reviewed 17 cases of electron microscopy-confirmed membranous glomerulonephritis in kidney allograft. In addition, they searched for other features of graft injury, particularly lesions associated with alloimmune reaction, in order to evaluate the contribution of each lesion to the long-term outcome of the allograft.
In 4 of the 17 cases of their series the diagnosis of membranous glomerulopathy was made by electron microscopy. In addition, in 5 samples, lesions of chronic alloimmune rejection were present (in 4 cases the diagnosis was based on electron microscopy findings). At the end point of the study, 3 of the 5 patients with chronic alloimmune injury were in dialysis, 1 had died with functioning allograft, and the fifth suffered severe renal failure but was not in dialysis. On the other hand, 3 of the 12 patients without evidence of alloimmune injury had returned to the dialysis program.
Electron microscopy is a useful tool in the assessment of renal allograft pathology and can provide additional morphological features of prognostic relevance.
膜性肾小球病是同种异体肾移植常见的并发症。然而，其发病率和预后尚不明确，因为在慢性移植肾肾病这一统称下，有数量不明的病例未被诊断出来。
为评估电子显微镜检查相对于传统光学显微镜和免疫荧光检查在诊断方面的优势，作者回顾了17例经电子显微镜确诊的同种异体肾移植膜性肾小球肾炎病例。此外，他们还寻找移植肾损伤的其他特征，特别是与同种免疫反应相关的病变，以评估每种病变对移植肾长期预后的影响。
在他们系列研究的17例病例中，有4例通过电子显微镜检查确诊为膜性肾小球病。此外，在5个样本中存在慢性同种免疫排斥反应病变（4例诊断基于电子显微镜检查结果）。在研究终点时，5例患有慢性同种免疫损伤的患者中，3例需要透析，1例在移植肾仍有功能时死亡，第5例患有严重肾衰竭但未进行透析。另一方面，12例无同种免疫损伤证据的患者中有3例重新开始透析治疗。
电子显微镜检查是评估同种异体肾移植病理的有用工具，可提供具有预后相关性的额外形态学特征。
