Salinas-Madrigal L, Sotelo-Avila C
Am J Kidney Dis. 1986 Jan;7(1):84-7. doi: 10.1016/s0272-6386(86)80060-9.
The histologic diagnosis of acute tubular necrosis (ATN) frequently poses considerable difficulty, especially in its early phases. This is particularly true in postmortem material in which autolysis is commonly present. This study was designed to assess the value of enhanced autofluorescence in the diagnosis of ATN. The method has previously been shown to be useful in the identification of myocardial infarcts in both humans and experimental animals. We studied 12 patients with a histologic and clinical diagnosis of ATN. In all, severe hypotension of diverse etiology was detected from 15 hours to seven days prior to death. In all cases, a bright yellow autofluorescence was observed in the necrotic tubules in ordinary H & E sections. In addition, enhanced autofluorescence was observed in the necrotic tubular epithelium in the unstained, paraffin-embedded sections. Nine kidney sections from five medico-legal autopsy cases undergoing autolysis from 11 to 48 hours after death were used as controls. These kidneys invariably exhibited a faint dull olive green fluorescence, quite different from the fluorescence of the necrotic tubules. No effort was made to distinguish between ischemic (tubulorrhexis) and toxic (tubulonecrosis) changes by the fluorescent method. The mechanism of the enhanced autofluorescence is not clear. We conclude that ultraviolet light examination of H & E kidney sections allows accurate recognition of ATN.
急性肾小管坏死（ATN）的组织学诊断常常颇具难度，尤其是在其早期阶段。在通常存在自溶现象的尸检材料中更是如此。本研究旨在评估增强自发荧光在ATN诊断中的价值。此前已证明该方法在识别人类和实验动物的心肌梗死方面有用。我们研究了12例经组织学和临床诊断为ATN的患者。所有患者在死亡前15小时至7天均检测到不同病因的严重低血压。在所有病例中，在普通苏木精和伊红（H&E）切片的坏死肾小管中观察到亮黄色自发荧光。此外，在未染色的石蜡包埋切片的坏死肾小管上皮中观察到增强的自发荧光。来自5例死后11至48小时正在自溶的法医尸检病例的9个肾脏切片用作对照。这些肾脏始终呈现出微弱的暗橄榄绿色荧光，与坏死肾小管的荧光截然不同。未尝试通过荧光方法区分缺血性（肾小管破裂）和中毒性（肾小管坏死）变化。增强自发荧光的机制尚不清楚。我们得出结论，对肾脏H&E切片进行紫外线检查可准确识别ATN。
