Singh Kamaljeet, Ray Ruma, Sharma Alok, Gupta Ruchika, Bagga Arvind, Dinda Amit K
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Saudi J Kidney Dis Transpl. 2013 Sep;24(5):942-9. doi: 10.4103/1319-2442.118091.
Nephrotic syndrome (NS) is a common renal disorder with significant tubulo-interstitial damage due to the combined effects of proteinuria and obstruction of efferent blood flow. Peritubular capillary (PTC) loss has also been correlated with interstitial fibrosis. This study included 30 pediatric cases of idiopathic NS. Clinical details, including biochemical parameters, were recorded and renal biopsy slides were reviewed for histological features. PTCs were highlighted using anti-CD34 antibody and quantified with the help of image analysis software. Postmortem kidney biopsies from seven children were taken as controls for quantification of PTCs and interstitial fibrosis. Wherever possible, as ultrastructural examination of the renal biopsy was performed. Appropriate statistical methods were applied. Patients with minimal change disease (MCD) had lower serum creatinine as compared with those with focal and segmental glomerulosclerosis (FSGS). Similarly, tubular atrophy and interstitial fibrosis were significantly lower in MCD than in FSGS. PTC density was lower in all groups of NS as compared with the controls. Biopsies with FSGS had a lower PTC density compared with both MCD and mesangioproliferative glomerulonephritis. PTC density showed a negative correlation with serum creatinine and degree of proteinuria. PTC loss appears to play an important role in the development of renal biopsy changes in pediatric NS. This aspect of the renal vasculature requires further study in idiopathic NS.
肾病综合征（NS）是一种常见的肾脏疾病，由于蛋白尿和出球血流受阻的综合作用，会导致显著的肾小管间质损伤。肾小管周围毛细血管（PTC）丢失也与间质纤维化相关。本研究纳入了30例儿童特发性NS病例。记录了包括生化参数在内的临床细节，并对肾活检切片进行了组织学特征检查。使用抗CD34抗体突出显示PTC，并借助图像分析软件进行定量。取7名儿童的尸检肾活检组织作为PTC定量和间质纤维化的对照。只要有可能，就对肾活检进行超微结构检查。应用了适当的统计方法。微小病变肾病（MCD）患者的血清肌酐低于局灶节段性肾小球硬化（FSGS）患者。同样，MCD患者的肾小管萎缩和间质纤维化明显低于FSGS患者。与对照组相比，所有NS组的PTC密度均较低。FSGS活检的PTC密度低于MCD和系膜增生性肾小球肾炎。PTC密度与血清肌酐和蛋白尿程度呈负相关。PTC丢失似乎在儿童NS肾活检改变的发展中起重要作用。在特发性NS中，肾血管系统的这一方面需要进一步研究。
