Bertani T, Cutillo F, Zoja C, Broggini M, Remuzzi G
Kidney Int. 1986 Oct;30(4):488-96. doi: 10.1038/ki.1986.212.
The present study was designed to investigate the relationship between proteinuria, focal sclerosis, and tubulo-interstitial changes in the evolution of renal damage in experimental nephrosis. We utilized an accelerated unilateral model of adriamycin (ADR) nephrosis characterized by morphological changes more severe than in the classical model. The first events in ADR-induced glomerulopathy were epithelial cell damage and proteinuria. Subsequently, tubular casts were formed at the distal level. The cast formation preceded the development of interstitial damage, which was determined by tubular obstruction and breaking of tubular basement membrane (TBM), which in turn promoted an interstitial inflammatory reaction. Despite the severity of tubulo-interstitial damage observed after a long period of heavy proteinuria, the incidence of focal segmental glomerulosclerosis (FSG) was very low. The results of the present study indicate that chronic proteinuria is not necessarily accompanied by the development of focal sclerosis. Tubulo-interstitial lesions appear to be the most important determinant for the progression of renal damage in this model.
本研究旨在探讨实验性肾病肾损伤进展过程中蛋白尿、局灶性硬化和肾小管间质变化之间的关系。我们采用了阿霉素（ADR）肾病的加速单侧模型，其特征是形态学变化比经典模型更为严重。ADR诱导的肾小球病的最初事件是上皮细胞损伤和蛋白尿。随后，在远端形成肾小管管型。管型形成先于间质损伤的发展，间质损伤是由肾小管梗阻和肾小管基底膜（TBM）破裂所决定的，而这反过来又促进了间质炎症反应。尽管在长期大量蛋白尿后观察到肾小管间质损伤严重，但局灶节段性肾小球硬化（FSG）的发生率非常低。本研究结果表明，慢性蛋白尿不一定伴有局灶性硬化的发展。在该模型中，肾小管间质病变似乎是肾损伤进展的最重要决定因素。
