Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease.
Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease.
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DOI：
10.1038/ki.2010.131
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发表时间：
2010-08
影响因子：
19.6
通讯作者：
Coe, Fredric L.
中科院分区：
文献类型：
--
作者：
Evan, Andrew P.;Lingeman, James E.;Worcester, Elaine M.;Bledsoe, Sharon B.;Sommer, Andre J.;Williams, James C., Jr.;Krambeck, Amy E.;Philips, Carrie L.;Coe, Fredric L.
迄今为止，尚未对结石和小肠切除术患者肾脏的手术解剖和组织病理学进行研究。我们在此报告11例病例的资料，其中10例为克罗恩病，1例在婴儿期因不明原因切除。结石主要是草酸钙（CaOx）。尿结石的风险包括一半病例的高草酸尿（尿草酸排泄量为45毫克/天），尿量和ph值减少。与回肠造口术和肥胖旁路术一样，内髓集管（IMCD）含有晶体沉积，伴有细胞损伤、间质炎症和乳头状畸形。皮层改变包括中度肾小球硬化、小管萎缩和间质纤维化。间质乳头状磷灰石（Randall’s）斑块丰富，CaOx结石在回肠造口、特发性CaOx结石形成和原发性甲状旁腺功能亢进的沉积物上生长。丰富的斑块与低尿量和ph相适应。IMCD沉积物均含有磷灰石；3例伴有CaOx。这与肥胖旁路手术的结果相似，但与回肠造口术不同。IMCD中CaOx的机制似乎包括尿升高，可能是小管液CaOx SS伴低钙与草酸盐比例；IMCD磷灰石普遍存在的机制尚不清楚。
To date, the surgical anatomy and histopathology of kidneys from patients with stones and small bowel resection have not been studied. We present here materials from 11 cases, 10 Crohn’s disease and one with resection in infancy for unknown cause. Stones are predominantly calcium oxalate (CaOx). Urine stone risks included hyperoxaluria (urine oxalate excretion > 45 mg/day) in half of the cases, and reduced urine volume and pH. As in ileostomy and obesity bypass, inner medullary collecting ducts (IMCD) contain crystal deposits with associated cell injury, interstitial inflammation and papillary deformity. Cortical changes include modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Interstitial papillary apatite (Randall’s) plaque is abundant, and CaOx stones grow over deposits as in ileostomy, idiopathic CaOx stone formers, and primary hyperparathyroidism. Abundant plaque is compatible with the low urine volume and pH. IMCD deposits all contain apatite; in 3 cases CaOx is also present. This is similar to findings in obesity bypass but not ileostomy. Mechanisms for CaOx in IMCD appear to include elevated urine, and presumably tubule fluid CaOx SS with a low calcium to oxalate ratio; mechanisms for the universal presence of IMCD apatite are unknown.
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影响因子：
4.5
作者：
Miller NL;Gillen DL;Williams JC Jr;Evan AP;Bledsoe SB;Coe FL;Worcester EM;Matlaga BR;Munch LC;Lingeman JE
通讯作者：
Lingeman JE
影响因子：
19.6
作者：
Evan, Andrew E.;Lingeman, James E.;Worcester, Elaine M.
通讯作者：
Worcester, Elaine M.
影响因子：
4.5
作者：
Parks, Joan H.;Coe, Fredric L.;Worcester, Elaine M.
通讯作者：
Worcester, Elaine M.
影响因子：
19.6
作者：
Evan, A. P.;Lingeman, J.;Worcester, E.
通讯作者：
Worcester, E.
影响因子：
6.6
作者：
Parks, JH;Goldfisher, E;Coe, FL
通讯作者：
Coe, FL