Herrera G A, Isaac J, Turbat-Herrera E A
Department of Pathology, Louisiana State University, Shreveport 71130, USA.
Ultrastruct Pathol. 1997 Nov-Dec;21(6):481-98. doi: 10.3109/01913129709016365.
The crucial role that electron microscopy plays in diagnostic renal pathology is undisputed. By allowing recognition of findings not identifiable by light microscopic evaluation, electron microscopy has contributed significantly to the understanding of renal diseases and has proven to be of unquestionable value in many diagnostic situations. However, the percentage of cases in which electron microscopic examination adds important information that is either key for establishing or confirming a diagnosis or provides valuable data that influence patient's management remains controversial. This figure depends on the renal biopsy service that is surveyed, but it is reported that on the average ultrastructural evaluation is of value in approximately 30 to 45% of the cases. Correct interpretation of a renal biopsy depends on the ability to correlate light, immunofluorescence, and ultrastructural findings. In contrast, the role of electron microscopy in the examination of renal transplant specimens remains controversial. Many centers do not use routine electron microscopy to examine these specimens and insist that there are only a few specific indications that require ultrastructural evaluation. There is general agreement among renal pathologists that electron microscopy is of importance in the evaluation of renal specimens from patients with proteinuria to distinguish between transplant glomerulopathy, recurrent or de novo glomerulonephritis in order to correctly manage these patients and predict survival of the graft. The other possible indications are much more controversial. This paper summarizes and critically reviews the literature available on this subject and defines recommendations based on the information available at the current time.
电子显微镜在诊断性肾脏病理学中所起的关键作用是无可争议的。通过能够识别光镜评估无法辨别的发现，电子显微镜对理解肾脏疾病做出了重大贡献，并且在许多诊断情况下已被证明具有毋庸置疑的价值。然而，电子显微镜检查能增添重要信息（这些信息对于确立或证实诊断至关重要，或者能提供影响患者治疗管理的有价值数据）的病例所占百分比仍存在争议。这个数字取决于所调查的肾脏活检服务情况，但据报道，平均而言，超微结构评估在大约30%至45%的病例中具有价值。对肾脏活检的正确解读取决于将光镜、免疫荧光和超微结构发现相互关联的能力。相比之下，电子显微镜在肾移植标本检查中的作用仍存在争议。许多中心不使用常规电子显微镜检查这些标本，并坚称只有少数特定指征需要进行超微结构评估。肾脏病理学家普遍认为，电子显微镜在评估蛋白尿患者的肾脏标本以区分移植肾小球病、复发性或新发肾小球肾炎方面很重要，以便正确管理这些患者并预测移植物的存活情况。其他可能的指征则更具争议性。本文总结并批判性地回顾了关于该主题的现有文献，并根据当前可得信息给出建议。
