Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy
Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy
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DOI：
10.1016/j.kint.2017.09.012
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发表时间：
2018-03-01
影响因子：
19.6
通讯作者：
Murray, Kristy O.
中科院分区：
文献类型：
--
作者：
Fischer, Rebecca S. B.;Vangala, Chandan;Murray, Kristy O.
中美洲肾病是一种原因不明的破坏性疾病，主要影响中美洲的年轻农业工人。迫切需要了解伤害的机制和早期的疾病过程，这将有助于确定根本原因以及直接的治疗和预防努力。我们试图在尼加拉瓜前瞻性确诊的急性病例中描述中美洲肾病最早临床表现的肾脏病理。我们考虑那些血清肌酐升高(或至少增加0.3 mg/dL或比基线增加1.5倍)、白细胞增多、白细胞增多或中性粒细胞增多的患者包括在本活检研究中。超声引导下取肾组织进行光镜、免疫荧光和电子显微镜检查。所有11名接受肾活检的患者均表现为肾小管间质肾炎，并伴有不同程度的炎症和慢性化。间质细胞浸润(主要是T淋巴细胞和单核细胞)，主要在皮髓交界处；中性粒细胞聚集在管腔内；基本保留肾小球；很少有轻度缺血性改变；没有观察到免疫沉积。肾小管间质性肾炎的急性成分为急性肾小管细胞损伤、间质水肿和早期纤维化。慢性间质性肾炎包括严重的肾小管萎缩、肾小管基底膜增厚和间质纤维化。因此，中美肾病的肾脏组织病理学显示肾小球完整的原发间质病变。
Mesoamerican nephropathy is a devastating disease of unknown etiology that affects mostly young agricultural workers in Central America. An understanding of the mechanism of injury and the early disease process is urgently needed and will aid in identification of the underlying cause and direct treatment and prevention efforts. We sought to describe the renal pathology in Mesoamerican nephropathy at its earliest clinical appearance in prospectively identified acute case patients in Nicaragua. We considered those with elevated (or increased at least 0.3 mg/dL or 1.5-fold from baseline) serum creatinine, leukocyturia, and either leukocytosis or neutrophilia for inclusion in this biopsy study. Renal tissue was obtained by ultrasound-guided biopsy for examination by light, immunofluorescence, and electron microscopy. All 11 individuals who underwent renal biopsy showed tubulointerstitial nephritis, with varying degrees of inflammation and chronicity. Interstitial cellular infiltrates (predominantly T lymphocytes and monocytes), mostly in the corticomedullary junction; neutrophilic accumulation in the tubular lumens; largely preserved glomeruli; few mild ischemic changes; and no immune deposits were noted. The acute components of tubulointerstitial nephritis were acute tubular cell injury, interstitial edema, and early fibrosis. Chronic tubulointerstitial nephritis included severe tubular atrophy, thickened tubular basement membrane, and interstitial fibrosis. Thus, renal histopathology in Mesoamerican nephropathy reveals primary interstitial disease with intact glomeruli.