Salwa-Zurawska W, Woźniak A, Biczysko W, Bortkiewicz E, Kaczmarek E, Maciejewski J
Department of Clinical Pathomorphology, K. Marcinkowski University of Medical Sciences, Poznań.
Pol J Pathol. 1998;49(3):165-74.
Focal segmental glomerulosclerosis (FSGS) poses a major problem both from the clinical and pathomorphological viewpoint. The diagnosis of FSGS in its early stage is vital mainly because of rapidly developing therapeutic modalities. In the literature various changes are discussed which may be of prognostic value (may predict the development of FSGS). One the these changes in vacuolization, mainly of podocytes and less frequently of endothelial cells. The purpose of the present study was to analyse biopsy specimens to find out to what extent vacuolization of podocytes and endothelial cells is associated with FSGS. We compared vacuolization in minimal change disease (MCD), mesangial glomerulonephritis (GNMES) and FSGS. A similar analysis was made also with respect to those cases of MCD and GNMES, in which electron microscopy suggested an early stage of FSGS. In each group electron micrographs obtained from 15 children were analysed. Electron micrographs (12-15 on average) were obtained most frequently from 3 glomeruli. Each case electron micrographs contained 90-100 podocytes. Based upon the same electron micrographs we counted capillary lumina and defined the percentage of those which contained vacuolized endothelia (we counted the capillary lumina, and not the cells, because it is most frequently impossible to identify the border of vacuolized endothelial cells). The number of capillary cross-sections was 60 on average. The results of the analysis were compared with the clinical data. This comparison did not confirm the hypothesis of other investigators that vacuolization is of a prognostic value. Additionally we evaluated the character of vacuoles. Within podocytes the vacuoles were varying in shape. Surrounded by a single membranous layer most frequently they contained material corresponding to proteins or proteoglycans, rarely to lipids. Sometimes the vacuoles were autophagosomal, occasionally they consisted of the dilated rough endoplasmic reticulum. Vacuole-like changes within the capillary lumina were related to the swelling of endothelial cytoplasm or mesangial processes. The reasons for a discrepancy between our results and those reported by other investigators necessitate further studies.
局灶节段性肾小球硬化（FSGS）无论从临床还是病理形态学角度来看都是一个主要问题。FSGS早期诊断至关重要，主要是因为治疗方式发展迅速。文献中讨论了各种可能具有预后价值（可预测FSGS发展）的变化。其中一种变化是空泡化，主要见于足细胞，较少见于内皮细胞。本研究的目的是分析活检标本，以确定足细胞和内皮细胞的空泡化与FSGS的关联程度。我们比较了微小病变肾病（MCD）、系膜增生性肾小球肾炎（GNMES）和FSGS中的空泡化情况。对于那些电镜提示为FSGS早期阶段的MCD和GNMES病例也进行了类似分析。每组分析了15名儿童的电子显微镜照片。平均从3个肾小球获取最常见的电子显微镜照片（平均12 - 15张）。每个病例的电子显微镜照片包含90 - 100个足细胞。基于相同的电子显微镜照片，我们计数毛细血管腔，并确定其中含有空泡化内皮的毛细血管腔的百分比（我们计数的是毛细血管腔，而非细胞，因为最常见的情况是无法识别空泡化内皮细胞的边界）。毛细血管横截面积平均为60。将分析结果与临床数据进行比较。这种比较未证实其他研究者关于空泡化具有预后价值的假设。此外，我们评估了空泡的特征。足细胞内的空泡形状各异。它们最常被单层膜包围，内含与蛋白质或蛋白聚糖相对应的物质，很少含有脂质。有时空泡是自噬体，偶尔由扩张的粗面内质网组成。毛细血管腔内的空泡样变化与内皮细胞质肿胀或系膜突起有关。我们的结果与其他研究者报告的结果存在差异的原因需要进一步研究。
