Yoshiara S, White R H, Raafat F, Smith N C, Shah K J
Department of Nephrology, Children's Hospital, Birmingham, UK.
Pediatr Nephrol. 1993 Feb;7(1):15-22. doi: 10.1007/BF00861553.
Using computerized digitometry, we investigated the relationships between renal size, glomerular filtration rate (GFR), proteinuria, incidence of segmental and global glomerulosclerosis, glomerular size, hilar arteriolar wall thickness and hyaline deposition in renal biopsies obtained from 24 children and adolescents with reflux nephropathy, of whom only 4 were hypertensive. Age-matched controls comprised minimal-change nephrotic syndrome (6) and recurrent haematuria with normal biopsy (13). The mean sectional area of patients' glomeruli was double that of controls. Glomerular size correlated with the amount of proteinuria (measured as protein/creatinine ratios in early morning urine) and inversely with renal size and GFR. Segmental sclerosis, invariably of hilar origin, was observed in 8 patients and the percentage of glomeruli affected correlated strongly with glomerular size and proteinuria. Global sclerosis was found equally in patients and controls, and showed no similar correlations. Compared with controls, patients' hilar arterioles showed increased wall thickness, more intramural hyaline deposits and decreased luminal diameter when related to glomerular size. The proteinuria and glomerular changes are consistent with hyperfiltration, while the previously undescribed hilar vascular changes, which both precede and accompany sclerosis, resemble abnormalities reported experimentally following renal ablation.
我们使用计算机数字化测量法，研究了24例反流性肾病儿童和青少年肾活检标本中肾大小、肾小球滤过率（GFR）、蛋白尿、节段性和全球性肾小球硬化发生率、肾小球大小、肾门小动脉壁厚度以及透明质沉积之间的关系，其中仅有4例高血压患者。年龄匹配的对照组包括微小病变肾病综合征患者（6例）和活检正常的复发性血尿患者（13例）。患者肾小球的平均截面积是对照组的两倍。肾小球大小与蛋白尿量（以晨尿中蛋白/肌酐比值衡量）相关，与肾大小和GFR呈负相关。8例患者观察到节段性硬化，均起源于肾门，受累肾小球的百分比与肾小球大小和蛋白尿密切相关。患者和对照组中均发现全球性硬化，且未显示出类似的相关性。与对照组相比，患者的肾门小动脉壁厚度增加，壁内透明质沉积更多，与肾小球大小相关的管腔直径减小。蛋白尿和肾小球变化与超滤一致，而先前未描述的肾门血管变化，在硬化之前和伴随硬化出现，类似于肾切除术后实验报道的异常情况。
