Renal Pathology Division, Arkana Laboratories, 10810 Executive Center Dr., Suite 100, Little Rock, AR 72211, United States.
Renal Pathology Division, Arkana Laboratories, 10810 Executive Center Dr., Suite 100, Little Rock, AR 72211, United States.
Semin Diagn Pathol. 2020 May;37(3):127-134. doi: 10.1053/j.semdp.2020.02.001. Epub 2020 Feb 14.
The identification and proper characterization of pathologic renal intratubular casts can be an arduous task, especially since they often admixed with non-pathologic casts, obfuscating debris and inflammation. The list of pathologic intratubular casts is long, and they can be easily missed or misdiagnosed without a thorough understanding of their pathophysiology and morphologic variety. Correct characterization of tubular casts is important since each cast type has a unique pathogenic mechanism, with specific treatment and prognostic implications. This review discusses the clinicopathologic characteristics of the six most common pathologic casts: light chain, hemoglobin, myoglobin, red cell, neutrophilic and bile casts. We also discuss hyaline and uromodulin casts, the commonly encountered "benign" cast types that share certain histologic features with pathologic casts. We limit the discussion to proteinaceous and cellular intratubular casts, with crystalline casts discussed in a separate review within the same journal issue. While not exhaustive, this review covers pathogenesis, clinical and prognostic significance, and a practical discussion of the histomorphologic spectrum of each cast type, along with commonly encountered pitfalls.
识别和正确描述病理性肾内管型可能是一项艰巨的任务，尤其是因为它们经常与非病理性管型、混浊碎片和炎症混合在一起。病理性管型的种类繁多，如果不深入了解其病理生理学和形态多样性，很容易漏诊或误诊。正确描述管型很重要，因为每种管型都有独特的发病机制，具有特定的治疗和预后意义。本文讨论了六种最常见的病理性管型：轻链、血红蛋白、肌红蛋白、红细胞、中性粒细胞和胆色素管型的临床病理特征。我们还讨论了透明和尿调素管型，这两种常见的“良性”管型与病理性管型具有某些组织学特征。我们将讨论限制在蛋白质和细胞性管型内，结晶管型在同一期刊中的另一篇综述中进行了讨论。虽然不是详尽无遗，但本文涵盖了发病机制、临床和预后意义，以及每种管型的组织形态谱的实用讨论，以及常见的陷阱。
