急性肾小管坏死恢复或进展的病理特征：单中心研究
Pathological Features of Recovery or Progression in Acute Tubular Necrosis: Single Centre Study.
作者信息
Soliman Amin R, Boles Fadia M, Sadek Khaled M
机构信息
Department of Internal Medicine and Nephrology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt.
出版信息
Saudi J Kidney Dis Transpl. 2022 Feb;33(Supplement):S12-S17. doi: 10.4103/1319-2442.374378.
Acute tubular necrosis (ATN) is the most important and frequent cause of acute kidney injury (AKI). Controversy exists concerning the role of renal biopsy in the evaluation of ATN prognosis. We aim in our study to evaluate the role of renal biopsy for the detection of recovery and progression and rate of recovery of ATN. The study was designed to include all biopsies with the diagnosis in ATN in adults >21-year-old, from January 2016 to December 2018. Biopsies were recruited retrospectively and were reviewed by three pathologists and quantitated. Four histological ATN features were evaluated. Flattening cells, distension or dilatation, debris, and vacuolation and for each a score were attributed as follows: 0 = less than 5% of section, 1 = 6%-25%, 2 = 26%-50%, 3 = >50%. Thirty-five patients with 35 renal biopsies were analyzed. Flattening was seen <5% in nine patients, 6%-25% in 15 patients, 26%-50% in six patients. and >50% in five patients. Dilatation was seen <5% in 11 patient, 6%-25% in 10 patients, 26%-50% seen in six patients, and >50% in eight patients. The presence of debris was seen in <5% in 12 patients, 6%-25% in 12 patients, 26%-50% seen in six patients, and >50% seen in five patient. Vacuolation was seen in 5% in eight patients, 6%-25% in 14 patients, 26%-50% in seven patients, and >50% in six patients. It was found that flattening <5% and dilatation <5% and dilatation >50% in renal biopsy are the good indicators for recovery and good prognosis of cases of ATN, in addition debris <5% and >50% and vacuolation <5% are also good indicators for recovery and good prognosis of cases of ATN. On the other hand, flattening from 6% to 25% and from 26% to 50%, dilatation from 6% to 25%, debris from 26% to 50% and vacuolation >50% are also indicators for delayed recovery and poor prognosis of cases of ATN. Renal biopsy in AKI with the diagnosis of ATN with scoring system of flattening, dilatation, debris, and vacuolation can point to indication of recovery or progression of these cases.
急性肾小管坏死（ATN）是急性肾损伤（AKI）最重要且最常见的病因。关于肾活检在评估ATN预后中的作用存在争议。我们开展本研究旨在评估肾活检在检测ATN恢复、进展及恢复率方面的作用。该研究纳入了2016年1月至2018年12月期间年龄大于21岁的所有诊断为ATN的成人肾活检病例。肾活检病例通过回顾性招募，由三位病理学家进行复查并定量分析。评估了四种ATN组织学特征。细胞扁平、扩张或膨大、碎片及空泡形成，并对每种特征赋予如下评分：0 = 切片中小于5%，1 = 6% - 25%，2 = 26% - 50%，3 = >50%。对35例患者的35次肾活检进行了分析。细胞扁平情况：9例患者小于5%，15例患者为6% - 25%，6例患者为26% - 50%，5例患者大于50%。扩张情况：11例患者小于5%，10例患者为6% - 25%，6例患者为26% - 50%，8例患者大于50%。碎片存在情况：12例患者小于5%，12例患者为6% - 25%，6例患者为26% - 50%，5例患者大于50%。空泡形成情况：8例患者为5%，14例患者为6% - 25%，7例患者为26% - 50%，6例患者大于50%。研究发现，肾活检中细胞扁平小于5%、扩张小于5%以及扩张大于50%是ATN病例恢复及预后良好的良好指标，此外，碎片小于5%和大于50%以及空泡形成小于5%也是ATN病例恢复及预后良好的良好指标。另一方面，细胞扁平6%至25%以及26%至50%、扩张6%至25%、碎片26%至50%以及空泡形成大于50%也是ATN病例恢复延迟及预后不良的指标。在诊断为ATN的AKI中，采用细胞扁平、扩张、碎片及空泡形成评分系统的肾活检可指出这些病例的恢复或进展情况。
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