Mahajan Vrushali, Gowrishankar Swarnalata
Department of Histopathology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India.
Indian J Nephrol. 2024 Jul-Aug;34(4):310-316. doi: 10.25259/ijn_282_23. Epub 2024 Jun 4.
Acute tubular injury (ATI) is a common diagnosis on renal biopsy. There are no accepted parameters to assess the severity of injury or predict recovery. An objective histologic grading system would be of immense value in clinical practice. The macrophage response to injury involves the MI phenotype which is proinflammatory and M2 which is prorepair. The study of these macrophages could aid in studying the severity and the recovery.
A total of 58 native kidney biopsies with features of ATI and a minimum follow-up of 12 weeks were graded into mild, moderate and severe, using scores for simplification, sloughing, and mitosis. These scores and the density of macrophages stained with CD68, CD163, and HLA-DR were correlated with serum creatinine at presentation and with recovery. The effect of chronicity index as measured by glomerulosclerosis, tubular atrophy, and interstitial fibrosis and of co-morbidities of age, hypertension, and diabetes on the recovery pattern was also studied.
All three histologic scores and the grades of ATI showed positive correlation with the serum creatinine level. The densities of CD 68 + and CD163 + macrophages also showed a significant correlation with serum creatinine level. However, none of these these histological features nor the macrophage densities predicted clinical recovery. Age >60 years, hypertension, diabetes, and chronicity score on biopsy were indicators of partial and delayed recovery.
The histopathological semiquantitative scoring system can be used routinely to grade ATI. However none of the studied parameters predicted recovery.
急性肾小管损伤（ATI）是肾活检中常见的诊断结果。目前尚无公认的参数来评估损伤的严重程度或预测恢复情况。一种客观的组织学分级系统在临床实践中将具有巨大价值。巨噬细胞对损伤的反应涉及促炎的M1表型和促修复的M2表型。对这些巨噬细胞的研究有助于了解损伤的严重程度和恢复情况。
对58例具有ATI特征且随访至少12周的自体肾活检组织，采用简化、脱落和有丝分裂评分，将其分为轻度、中度和重度。这些评分以及用CD68、CD163和HLA-DR染色的巨噬细胞密度与就诊时的血清肌酐水平及恢复情况相关联。还研究了由肾小球硬化、肾小管萎缩和间质纤维化测量的慢性指数以及年龄、高血压和糖尿病等合并症对恢复模式的影响。
所有三个组织学评分和ATI分级均与血清肌酐水平呈正相关。CD68 +和CD163 +巨噬细胞的密度也与血清肌酐水平显著相关。然而，这些组织学特征和巨噬细胞密度均未预测临床恢复情况。年龄>60岁、高血压、糖尿病和活检时的慢性评分是部分恢复和延迟恢复的指标。
组织病理学半定量评分系统可常规用于ATI分级。然而，所研究的参数均未预测恢复情况。
