Renal Diseases With Organized Deposits An Algorithmic Approach to Classification and Clinicopathologic Diagnosis
Renal Diseases With Organized Deposits An Algorithmic Approach to Classification and Clinicopathologic Diagnosis
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DOI：
10.1043/1543-2165-134.4.512
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发表时间：
2010-04-01
影响因子：
4.6
通讯作者：
Turbat-Herrera, Elba A.
中科院分区：
文献类型：
--
作者：
Herrera, Guillermo A.;Turbat-Herrera, Elba A.
背景。大多数肾脏疾病与组织存款是相对罕见的情况下，和适当的病理特征决定了具体的诊断。具有特定临床相关性的不同实体已被认识到，其正确诊断对患者管理，治疗选择和诊断有影响。这些疾病的诊断取决于仔细评估的结果，光学显微镜连同免疫荧光和电子显微镜。本文的目的是描述一种有助于在光镜水平上对这些疾病进行病理评估的算法方法。在某些疾病中，免疫形态学参数短的电子显微镜提供了坚实的信息，建议或作出明确的诊断。然而，电子显微镜起着至关重要的作用，因为分离这些实体的标准往往受到电子显微镜结果的严重影响。这些条件中的每一个接受的诊断标准进行了讨论。本文所用的信息来自已发表的数据和作者的经验。结果。这些疾病中最常见的是淀粉样变性，在某些肾脏病理实践中，淀粉样变性可能占所有肾活检的5%至8%。纤维性、免疫类和冷球蛋白血症性肾小球病一起最多占所有内科肾脏疾病肾活检的1%。糖尿病纤维性病变也不常见。与纤连蛋白沉积相关的肾小球病和胶原纤维化肾小球病极其罕见。结论。-对这些疾病患者的肾活检进行系统的算法评价非常有助于在活检评价的早期阶段排除某些情况。然而，只有在电子显微镜检查后才能达到最终的明确诊断并不罕见。(Arch Pathol Lab Med.2010; 134：512-531）
Context.-Most renal diseases with organized deposits are relatively uncommon conditions, and proper pathologic characterization determines the specific diagnosis. Different entities with specific clinical correlates have been recognized, and their correct diagnosis has an impact on patient management, treatment options, and determination of prognosis.Objective.-The diagnosis of these conditions depends on careful evaluation of the findings by light microscopy together with immunofluorescence and electron microscopy. The objective of this manuscript is to delineate an algorithmic approach helpful in the pathologic assessment of these conditions at the light microscopic level. In some diseases, the immunomorphologic parameters short of electron microscopy provide solid information to suggest or make a definitive diagnosis. Nevertheless, electron microscopy plays a crucial role, because the criteria to separate these entities often are heavily influenced by the electron microscopic findings. Accepted diagnostic criteria for each of these conditions are discussed.Design.-Information used for this manuscript is gathered from published data and the authors' experience. Results.-The most common of these conditions is amyloidosis, which may account for as many as 5% to 8% of all renal biopsies in some renal pathology practices. Fibrillary, immunotactoid, and cryoglobulinemic glomerulopathies together represent, at most, 1% of all renal biopsies performed for medical renal diseases. Diabetic fibrillosis also is uncommon. Glomerulopathies associated with fibronectin deposits and collagenofibrotic glomerulopathy are extremely rare.Conclusions.-A systematic, algorithmic approach to the evaluation of the renal biopsies from patients with these disorders is very helpful to rule out certain conditions in the early stages of the evaluation of the biopsies. However, it is not uncommon for the final definitive diagnosis to be reached only after electron microscopic evaluation. (Arch Pathol Lab Med. 2010; 134:512-531)