The pathology of jaundice-related renal insufficiency: cholemic nephrosis revisited.
The pathology of jaundice-related renal insufficiency: cholemic nephrosis revisited.
复制标题
黄疸相关肾功能不全的病理学：胆汁性肾病再论。
作者：
M. Betjes;I. Bajema
黄疸相关肾病的范围可以从局限性近端肾小管病变到肾衰竭。后一种情况在早期文献中被称为胆毒性肾病。胆汁盐和胆红素结合或不结合的血浆浓度升高介导肾毒性。肾小管细胞的功能紊乱被认为是肾病的基础，但关于肾组织学的已发表数据很少。在这份报告中，我们描述了两个肾活检的黄疸患者肌酐清除率降低，我们批判性地审查了文献的发病机制，黄疸相关的肾病。在黄疸相关性肾功能衰竭中均观察到正常的肾结构（表明功能性肾损害）和广泛的肾小管坏死。这些发现符合最初对胆源性肾病的描述。胆红素和胆盐在动物模型中都是潜在的肾毒素，但它们在黄疸相关肾病发病机制中的确切作用尚不清楚。胆红素血浆浓度>20 mg/dL、低血清白蛋白浓度或内毒素血症的患者可能更容易因黄疸相关肾小管病变而发生肾衰竭。总之，黄疸相关性肾病本质上是一种肾小管病变，但确切的发病机制仍不确定。
The spectrum of jaundice-related nephropathy can range from limited proximal tubulopathy to renal failure. The latter condition was known as cholemic nephrosis in the early literature on this subject. Elevated plasma concentrations of bile salts and bilirubin conjugated or not, putatively mediate the nephrotoxicity. A functional derangement of renal tubule cells is considered to underlie the nephropathy, but published data on renal histology are scarce. In this report, we describe the renal biopsies of two jaundiced patients with reduced creatinine clearance, and we critically review the literature on the pathogenesis of jaundice-related nephropathy. Normal renal architecture, indicating functional renal impairment, and extensive renal tubule necrosis were both observed in jaundice-related renal failure. The findings fit the original description of cholemic nephrosis. Both bilirubin and bile salts are potential nephrotoxins in animal models, but their precise role in the pathogenesis of jaundice-related nephropathy is not known. Patients with bilirubin plasma concentrations >20 mg/dL, a low serum albumin concentration or endo-toxemia, could be more prone to develop renal failure due to jaundice-related tubulopathy. In conclusion, jaundice-related nephropathy is essentially a tubulopathy, but the exact nature of the Pathogenesis is still uncertain.