Wichapoon Benjamas, Punsawad Chuchard, Viriyavejakul Parnpen
Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
School of Medicine, Walailak University, 222 Thasala District, Nakhon Si Thammarat, 80161, Thailand.
Nephrology (Carlton). 2017 Jan;22(1):79-84. doi: 10.1111/nep.12715.
In Plasmodium falciparum malaria, the clinical manifestation of acute kidney injury (AKI) is commonly associated with acute tubular necrosis (ATN) in the kidney tissues. Renal tubular cells often exhibit various degrees of cloudy swelling, cell degeneration, and frank necrosis. To study individual cell death, this study evaluates the degree of renal tubular necrosis in association with apoptosis in malarial kidneys.
Kidney tissues from P. falciparum malaria with AKI (10 cases), and without AKI (10 cases) were evaluated for tubular pathology. Normal kidney tissues from 10 cases served as controls. Tubular necrosis was assessed quantitatively in kidney tissues infected with P. falciparum malaria, based on histopathological evaluation. In addition, the occurrence of apoptosis was investigated using cleaved caspase-3 marker. Correlation between tubular necrosis and apoptosis was analyzed.
Tubular necrosis was found to be highest in P. falciparum malaria patients with AKI (36.44% ± 3.21), compared to non-AKI (15.88% ± 1.63) and control groups (2.58% ± 0.39) (all p < 0.001). In the AKI group, the distal tubules showed a significantly higher degree of tubular necrosis than the proximal tubules (p = 0.021) and collecting tubules (p = 0.033). Tubular necrosis was significantly correlated with the level of serum creatinine (r = 0.596, p = 0.006), and the occurrence of apoptosis (r = 0.681, p = 0.001).
In malarial AKI, the process of apoptosis occurs in ATN.
在恶性疟原虫疟疾中，急性肾损伤（AKI）的临床表现通常与肾组织中的急性肾小管坏死（ATN）相关。肾小管细胞常表现出不同程度的浊肿、细胞变性和明显坏死。为研究单个细胞死亡情况，本研究评估了疟疾肾脏中肾小管坏死程度与凋亡的关系。
对10例伴有AKI的恶性疟原虫疟疾患者和10例不伴有AKI的患者的肾组织进行肾小管病理学评估。10例正常肾组织作为对照。基于组织病理学评估，对感染恶性疟原虫疟疾的肾组织中的肾小管坏死进行定量评估。此外，使用裂解的半胱天冬酶-3标记物研究凋亡的发生情况。分析肾小管坏死与凋亡之间的相关性。
与非AKI组（15.88%±1.63）和对照组（2.58%±0.39）相比，伴有AKI的恶性疟原虫疟疾患者的肾小管坏死程度最高（36.44%±3.21）（所有p<0.001）。在AKI组中，远端肾小管的坏死程度明显高于近端肾小管（p=0.021）和集合小管（p=0.033）。肾小管坏死与血清肌酐水平显著相关（r=0.596，p=0.006），与凋亡的发生也显著相关（r=0.681，p=0.001）。
在疟疾相关性AKI中，凋亡过程发生于急性肾小管坏死。
