Mustonen J, Helin H, Pietilä K, Brummer-Korvenkontio M, Hedman K, Vaheri A, Pasternack A
Department of Clinical Medicine, University of Tampere, Finland.
Clin Nephrol. 1994 Mar;41(3):121-6.
A series of 126 adult patients with a serologically confirmed diagnosis of nephropathia epidemica (NE) were studied during the acute phase of the disease. In 86 cases, renal biopsy was performed. The severity of renal failure correlated slightly with blood inflammatory parameters and the degree of hematuria but not with the amount of proteinuria. The degree of hematuria correlated inversely with the level of thrombocytopenia. The most common histopathologic lesion was acute tubulointerstitial nephritis. Interstitial edema and inflammatory cell infiltrations were most usually present, followed by tubular epithelial and luminal alterations. Slight glomerular mesangial changes were present in 25% of the biopsy specimens. Except for hemorrhage in the outer renal medulla, the histologic lesions were relatively mild and unspecific. Interstitial hemorrhage should remind a pathologist of the possibility of NE. Tubular, interstitial and glomerular histologic damage were but vascular lesions were not associated with the clinical severity of renal failure. Glomerular alterations did not relate to the amount of urine protein excretion. Correlations, however, were so weak that in clinical work renal biopsy is usually not indicated for determination of the severity of renal failure in NE. Intrinsic renal events are probably important in the development of renal failure in NE.
对126例血清学确诊为流行性肾病（NE）的成年患者在疾病急性期进行了研究。其中86例进行了肾活检。肾衰竭的严重程度与血液炎症参数及血尿程度有轻微相关性，但与蛋白尿的量无关。血尿程度与血小板减少水平呈负相关。最常见的组织病理学病变是急性肾小管间质性肾炎。通常存在间质水肿和炎性细胞浸润，其次是肾小管上皮和管腔改变。25%的活检标本存在轻微的肾小球系膜改变。除肾外髓质出血外，组织学病变相对较轻且无特异性。间质出血应提醒病理学家注意NE的可能性。肾小管、间质和肾小球的组织学损伤存在，但血管病变与肾衰竭的临床严重程度无关。肾小球改变与尿蛋白排泄量无关。然而，相关性很弱，以至于在临床工作中，通常不建议进行肾活检来确定NE中肾衰竭的严重程度。肾内事件可能在NE肾衰竭的发生中起重要作用。
