Mannan Rahul, Singh Pramela Anthony, Misra Vatsala, Singh Mamta, Mehrotra Ravi, Tewarson Sneh Lata, Gupta Arvind, Manjari Mridu
Associate Professor, Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research , Amritsar, Punjab, India .
Professor, Department of Pathology, MLN Medical College , Allahabad, Uttar Pradesh, India .
J Clin Diagn Res. 2015 Apr;9(4):EC01-6. doi: 10.7860/JCDR/2015/12330.5785. Epub 2015 Apr 1.
Pauci-immune glomerulonephritis is the commonest cause of rapidly progressive glomerulonephritis (RPGN) which is associated with increased mortality and morbidity. More than 90% of these patients have serological presence of either antineutrophil cytoplasmic antibodies (ANCA), of cytoplamic (C) or perinuclear (P) type. "Immunofluoresence studies" exhibiting minimal or no fluorescence is diagnostic in all such cases. The present study aims to study the differences between renal biopsies of serologically ANCA negative versus ANCA positive individuals.
One hundred and twenty renal biopsies (of clinically suspected cases of systemic vasculitis) were sub-divided sub-divided under the heading of serologically ANCA positive and serologically ANCA negative; and scoring them by means of a semi-quantitative scoring system devised at the beginning of the study to identify statistically significant, specific light microscopic features in the sub-components of renal biopsy.
Fifteen parameters were found to be statistically significantly (p-value <0.05) in ANCA positive serological cases. These were glomerular capillary loop infiltration by neutrophils, cellular crescents, fibro-cellular crescents, glomerular fibrinoid necrosis, glomerular sclerosis, peri-glomerular infiltration, interstitial oedema, interstitial eosinophils, tubular atrophy, tubular necrosis, tubulitis, arterial hyalinization, arterial necrosis, arterial vessel wall polymorpho nuclear infiltrate and myointimal hypertrophy.
The presence of above parameters in a renal biopsy report of a patient (in absence of facilities of autoimmune serology and immunofluoresence) can alert both nephrologist and nephropathologist to keep a possibility of renal symptoms arising out of systemic vasculitis.
寡免疫性肾小球肾炎是快速进展性肾小球肾炎（RPGN）最常见的病因，与死亡率和发病率增加相关。这些患者中超过90%血清学上存在抗中性粒细胞胞浆抗体（ANCA），为胞浆型（C）或核周型（P）。在所有此类病例中，“免疫荧光研究”显示极少或无荧光具有诊断意义。本研究旨在探讨血清学ANCA阴性与ANCA阳性个体肾活检之间的差异。
120例（临床疑似系统性血管炎病例）肾活检标本根据血清学ANCA阳性和血清学ANCA阴性进行分类；并通过研究开始时设计的半定量评分系统对其进行评分，以识别肾活检亚成分中具有统计学意义的特定光镜特征。
在血清学ANCA阳性病例中，有15个参数具有统计学意义（p值<0.05）。这些参数为中性粒细胞浸润肾小球毛细血管袢、细胞性新月体、纤维细胞性新月体、肾小球纤维蛋白样坏死、肾小球硬化、肾小球周围浸润、间质水肿、间质嗜酸性粒细胞、肾小管萎缩、肾小管坏死、肾小管炎、动脉玻璃样变、动脉坏死、动脉血管壁多形核浸润及肌内膜肥大。
在患者的肾活检报告中出现上述参数（在缺乏自身免疫血清学和免疫荧光检查设备的情况下），可提醒肾内科医生和肾病理学家考虑系统性血管炎引起肾脏症状的可能性。
