A novel approach to the histological diagnosis of pediatric nephrotic syndrome by low vacuum scanning electron microscopy
A novel approach to the histological diagnosis of pediatric nephrotic syndrome by low vacuum scanning electron microscopy
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DOI：
10.2220/biomedres.35.227
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发表时间：
2014-08-01
影响因子：
1.2
通讯作者：
Kanzaki, Susumu
中科院分区：
文献类型：
--
作者：
Okada, Shinichi;Inaga, Sumire;Kanzaki, Susumu
尽管强化治疗，类固醇耐药型肾病综合征（NS）往往进展为终末期肾病。因此，需要更准确和快速的组织学诊断来正确治疗此类患者。本研究的目的是介绍一种新的方法，通过低真空扫描电子显微镜（LVSEM）的组织学诊断小儿NS和描述的形态学差异，在肾小球之间的类固醇敏感和类固醇耐药NS标本。受试者包括三名类固醇敏感NS患者和四名类固醇耐药NS患者。常规肾活检石蜡切片用铂蓝（Pt蓝）或高碘酸六次甲基胺银（PAM）染色，并在LVSEM下以50 - 10，000倍的放大率直接观察。铂蓝染色切片显示肾小球足细胞和足突的三维结构改变。PAM染色切片显示肾小球基底膜（GBM）的结构和厚度的变化。因此，许多圆形的足细胞和细长的初级足突被专门承认在类固醇耐药NS，虽然不规则的足突交错，融合，消失，和微绒毛转化中观察到类固醇敏感和类固醇耐药NS。激素耐药NS中可清楚地检测到刺激蛋白厚度和GBM的增加。LVSEM对小儿NS的肾组织学诊断有一定的参考价值。
Despite intensive treatment, steroid-resistant nephrotic syndrome (NS) often progresses to end-stage renal disease. Therefore, a more accurate and quick histological diagnosis is required to properly treat such patients. The aim of this study was to introduce a novel approach to the histological diagnosis of pediatric NS by low vacuum scanning electron microscopy (LVSEM) and to describe the morphological differences in glomeruli between steroid-sensitive and steroid-resistant NS specimens. The subjects were three patients with steroid-sensitive NS and four patients with steroid-resistant NS. Conventional renal biopsy paraffin sections were stained with platinum-blue (Pt-blue) or periodic acid methenamine silver (PAM) and directly observed under LVSEM at magnifications between x50 and x10,000. The Pt-blue-stained sections showed three-dimensional structural alterations in glomerular podocytes and foot processes. PAM-stained sections showed changes in the structure and thickness of the glomerular basement membrane (GBM). Consequently, many round-shaped podocytes and elongated primary foot processes were exclusively recognized in steroid-resistant NS, although irregularities in foot process interdigitation, fusions, effacements, and microvillus transformations were observed in both steroid-sensitive and steroid-resistant NS. Irregularities in thickness and the wrinkling of GBMs were clearly detected in steroid-resistant NS. The evaluation by LVSEM is probably useful for the renal histological diagnosis of pediatric NS.