A quantitative ultrastructural study of renal pathology in fatal Plasmodium falciparum malaria
A quantitative ultrastructural study of renal pathology in fatal Plasmodium falciparum malaria
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DOI：
10.1111/j.1365-3156.2007.01881.x
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发表时间：
2007-09-01
影响因子：
3.3
通讯作者：
Pongponratn, Emsri
中科院分区：
文献类型：
--
作者：
Nguansangiam, Sudarat;Day, Nicholas P. J.;Pongponratn, Emsri
目的应用电镜技术研究寄生红细胞（PRBC）隔离在重症恶性疟急性肾功能衰竭发病机制中的作用。方法对63例死于重症恶性疟的东南亚成人肾组织进行超微病理学检查。定性和定量确定疾病的主要病理特征，包括PRBC和白细胞隔离。临床病理与尸检前临床表现和外周寄生虫计数的相关性。结果：在这一人群中，疟疾相关性肾功能衰竭的发病率很高（> 40%），并且该发病率、严重疟疾性贫血和休克之间存在相关性。病理特征包括PRBC在肾小球和肾小管间质血管中的隔离、急性肾小管损伤和由宿主单核细胞在肾小球毛细血管内积聚引起的轻度肾小球细胞过多。没有证据表明免疫复合物介导的肾小球肾炎被发现。有寄生虫隔离在肾脏和死前肾功能衰竭之间的相关性，虽然隔离的总体水平相对较低。固碳水平（结节+ PRBC）在疟疾相关性肾衰竭中显著高于无肾衰竭的致死性病例结论疟疾相关性肾功能衰竭是该人群恶性疟原虫重症疟疾常见的严重并发症，与急性肾小管损伤有关，与肾小球肾炎无关，并且与宿主单核细胞在肾脏中的定位以及PRBC的隔离有关。
OBJECTIVE To use electron microscopy to examine the role of parasitized red blood cell (PRBC) sequestration in the pathogenesis of acute renal failure in severe falciparum malaria.METHODS Ultrastructural pathological examination of renal tissues from Southeast Asian adults (n = 63) who died from severe falciparum malaria. Qualitative and quantitative determination of the major pathological features of disease, including PRBC and leukocyte sequestration. Clinico-pathological correlation with the pre-mortem clinical picture and peripheral parasite count.RESULTS There was a high incidence of malaria-associated renal failure in this population (> 40%) and a correlation between this incidence, severe malarial anaemia and shock. Pathological features included PRBC sequestration in glomerular and tubulo-interstitial vessels, acute tubular damage and mild glomerular hypercellularity resulting from the accumulation of host monocytes within glomerular capillaries. No evidence for an immune complex mediated glomerulonephritis was found. There was a correlation between parasite sequestration in the kidney and pre-mortem renal failure, although overall levels of sequestration were relatively low. Levels of sequestration (Knob+ PRBC) were significantly higher in malaria-associated renal failure than in fatal cases without renal failure (P = 0.005).CONCLUSION Malaria-associated renal failure is a common and serious complication of severe Plasmodium falciparum malaria in this population, associated with acute tubular injury rather than glomerulonephritis, and linked to localization of host monocytes in the kidney as well as sequestration of PRBCs.