Renal crystal deposits and histopathology in patients with cystine stones
Renal crystal deposits and histopathology in patients with cystine stones
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DOI：
10.1038/sj.ki.5000268
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发表时间：
2006-06-01
影响因子：
19.6
通讯作者：
Worcester, E. M.
中科院分区：
文献类型：
--
作者：
Evan, A. P.;Coe, F. L.;Worcester, E. M.
我们对患有胱氨酸结石的患者的乳头进行了活检，询问这种结石类型是否与特定的组织变化有关。我们研究了七个胱氨酸结石形成者（SF）经皮肾镜取石术使用数字视频成像的肾乳头映射，并获得乳头活检。通过常规光学和电子显微镜、红外光谱、电子衍射和微型CT对活检进行分析。许多Bellini管（BD）有一个扩大的开口，所有这些都被胱氨酸晶体堵塞，并有受损或缺失的衬里细胞，周围有发炎至纤维化的纤维组织。晶体栓经常突入泌尿空间。许多内髓集合管（IMCD）扩张，伴或不伴晶体堵塞。在Henle袢和IMCD的管腔中发现了磷灰石晶体。间质性Randall斑块的消失与非SF斑块相当。在皮质，肾小球陈旧和间质纤维化超过正常。胱氨酸在BD中结晶，可能导致细胞损伤、间质反应、肾单位阻塞，并可能诱导皮质改变和IMCD小管液pH调节丧失，导致磷灰石形成。IMCD扩张和髓样结构丢失的模式与这种梗阻最相符，无论是BD管腔堵塞还是结石本身引起的尿路梗阻。
We have biopsied the papillae of patients who have cystine stones asking if this stone type is associated with specific tissue changes. We studied seven cystine stone formers (SF) treated with percutaneous nephrolithotomy using digital video imaging of renal papillae for mapping and obtained papillary biopsies. Biopsies were analyzed by routine light and electron microscopy, infrared spectroscopy, electron diffraction, and micro-CT. Many ducts of Bellini (BD) had an enlarged ostium, and all such were plugged with cystine crystals, and had injured or absent lining cells with a surrounding interstitium that was inflamed to fibrotic. Crystal plugs often projected into the urinary space. Many inner medullary collecting ducts (IMCD) were dilated with or without crystal plugging. Apatite crystals were identified in the lumens of loops of Henle and IMCD. Abundance of interstitial Randall's plaque was equivalent in amount to that of non-SF. In the cortex, glomerular obsolescence and interstitial fibrosis exceeded normal. Cystine crystallizes in BD with the probable result of cell injury, interstitial reaction, nephron obstruction, and with the potential of inducing cortical change and loss of IMCD tubular fluid pH regulation, resulting in apatite formation. The pattern of IMCD dilation, and loss of medullary structures is most compatible with such obstruction, either from BD lumen plugs or urinary tract obstruction from stones themselves.