Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
Kidney Int. 2014 Mar;85(3):668-76. doi: 10.1038/ki.2013.351. Epub 2013 Sep 18.
The pathophysiology of medial arterial calcification in chronic kidney disease (CKD) is unclear but has been ascribed to phenotypic changes in vascular smooth muscle, possibly in conjunction with intimal proliferation and atherosclerosis. As the prevalence of calcification in breast arteries is increased in women with CKD and end-stage renal disease (ESRD), this was examined histologically in mastectomy specimens from 19 women with CKD or ESRD. Arterial calcification was present in 18, was exclusively medial, and occurred in vessels as small as arterioles. Intimal thickening was common but unrelated to calcification. There was no evidence of atherosclerosis. The earliest calcification presented as small punctate lesions scattered throughout the media, often with calcification of the internal elastic lamina. Arterial calcification was present in all samples from an age- and diabetes-matched cohort without CKD but was much milder. While smooth muscle cell density was reduced one-third in arteries from patients with ESRD, the cells appeared normal, expressed SM22α, and exhibited no apoptosis. Staining for the bone-specific protein osteocalcin, the osteoblastic transcription factors Runx2 or osterix, or the chondrocytic transcription factor SOX9 was absent in regions of early calcification. Thus, medial calcification in breast arteries of patients with CKD can occur in the absence of smooth muscle cell apoptosis and/or osteogenic transdifferentiation. This suggests that the pathologic mineralization process may differ from one arterial type to the other.
慢性肾脏病（CKD）患者的中层动脉钙化的病理生理学尚不清楚，但已归因于血管平滑肌的表型变化，可能与内膜增生和动脉粥样硬化有关。由于 CKD 和终末期肾病（ESRD）女性的乳腺动脉钙化患病率增加，因此在 19 名 CKD 或 ESRD 女性的乳房切除术标本中进行了组织学检查。18 例存在动脉钙化，均为中层，发生于小至小动脉的血管。内膜增厚很常见，但与钙化无关。没有动脉粥样硬化的证据。最早的钙化表现为散布在整个中膜的小点状病变，常伴有内弹性膜钙化。在没有 CKD 的年龄和糖尿病匹配队列的所有样本中都存在动脉钙化，但程度要轻得多。虽然 ESRD 患者的动脉平滑肌细胞密度减少了三分之一，但细胞看起来正常，表达 SM22α，没有凋亡。在早期钙化区域，骨特异性蛋白骨钙素、成骨转录因子 Runx2 或osterix 或软骨细胞转录因子 SOX9 的染色均为阴性。因此，CKD 患者乳腺动脉的中层钙化可在平滑肌细胞凋亡和/或成骨转化缺失的情况下发生。这表明病理矿化过程可能不同于其他动脉类型。
