Mandal A K, Sklar A H, Hudson J B
Kidney Int. 1985 Jul;28(1):58-63. doi: 10.1038/ki.1985.118.
Urinary sediments from 31 patients with acute tubular necrosis (ATN) were studied using transmission electron microscopy (TEM). Variable quantities of renal tubule cells (RTCs), characterized by abundant cytoplasmic organelles, were a consistent finding in these sediments. TEM analyses of well-preserved RTCs permitted identification of their nephron segment(s) of origin. On the basis of the severity of ultrastructural changes observed, the sediments were divided into three types. Type I (N = 11) and II (N = 8) consisted of homogeneous populations of severely and mildly affected RTCs, respectively, while Type III (N = 12) sediments were composed of a heterogeneous population of variably affected cells. A correlation was found between the sediment type and the severity of the clinical illness. Of the 11 patients with Type I sediments, only two survived and they required chronic dialysis support. In contrast, seven of eight patients exhibiting Type II sediments survived, with only one requiring temporary dialysis therapy. Patients with Type III sediments had an intermediate course, with six of seven survivors regaining sufficient renal function to remain off dialysis over a 3-month period of observation. Our study suggests that TEM of urinary sediment can provide a useful non-invasive means of studying patients with ATN.
运用透射电子显微镜（TEM）对31例急性肾小管坏死（ATN）患者的尿沉渣进行了研究。这些尿沉渣中始终能发现数量不等的肾小管细胞（RTCs），其特征为含有丰富的细胞质细胞器。对保存良好的RTCs进行TEM分析，得以确定其起源的肾单位节段。根据观察到的超微结构变化的严重程度，将尿沉渣分为三种类型。I型（N = 11）和II型（N = 8）分别由严重和轻度受影响的RTCs同质群体组成，而III型（N = 12）尿沉渣则由受影响程度各异的异质细胞群体组成。发现尿沉渣类型与临床疾病严重程度之间存在相关性。在11例I型尿沉渣患者中，仅2例存活，且他们需要长期透析支持。相比之下，表现为II型尿沉渣的8例患者中有7例存活，仅1例需要临时透析治疗。III型尿沉渣患者病程处于中间状态，7例幸存者中有6例在3个月的观察期内恢复了足够的肾功能，无需透析。我们的研究表明，尿沉渣的TEM检查可为研究ATN患者提供一种有用的非侵入性方法。
