Salomon M I, Silva F, Tchertkoff V, Ayuthia I, Pirani C L
Nephron. 1978;22(4-6):409-17. doi: 10.1159/000181483.
Many patients with chronic pancreatitis (CP), even in the absence of intrinsic renal disease, are found to have abnormal urine, with persistent proteinuria, cylindruria, microhematuria and leukocyturia. The kidneys of 12 necropsy cases with CP showed mild to moderate arterial and arteriolar nephrosclerosis and no other significant changes. Renal biopsies were performed in 10 patients with CP without evidence of systemic disease or intrinsic renal disease, but with persistent urinary abnormalities. By light microscopy, mild arterial and arteriolar nephrosclerosis was present in 5 instances. In 1 patient, evidence of the reparative phase of acute tubular necrosis was noted. In 5 biopsies, electron microscopy revealed minimal to mild increase in mesangial matrix. Mild thickening of the glomerular basement membrane (GBM) was found in three instances but there was no clear-cut evidence of diabetic glomerulosclerosis. The presence of subendothelial electron-lucent material in 3 cases suggests the possibility of previous subclinical episodes of intravascular coagulation. The most consistent finding was the presence of lipid material in the cytoplasm of glomerular and tubular cells. The renal lesions associated with CP are mild, nonspecific and nonprogressive. Various pathogenetic factors can be invoked to account for their presence and for the urinary abnormalities found in patients with CP.
许多慢性胰腺炎（CP）患者，即使没有内在的肾脏疾病，也被发现有尿液异常，表现为持续性蛋白尿、管型尿、镜下血尿和白细胞尿。12例CP尸检病例的肾脏显示轻度至中度动脉和小动脉性肾硬化，无其他显著变化。对10例无全身性疾病或内在肾脏疾病证据，但有持续性尿液异常的CP患者进行了肾活检。光镜检查发现，5例存在轻度动脉和小动脉性肾硬化。1例患者有急性肾小管坏死修复期的证据。在5例活检中，电镜显示系膜基质有轻微至轻度增加。3例发现肾小球基底膜（GBM）轻度增厚，但没有明确的糖尿病性肾小球硬化证据。3例出现内皮下电子透亮物质提示可能有既往亚临床血管内凝血发作。最一致的发现是肾小球和肾小管细胞胞质内存在脂质物质。与CP相关的肾脏病变轻微、非特异性且无进展性。可以调用各种致病因素来解释它们的存在以及CP患者出现的尿液异常。
