肾脏肿瘤中的肾小球疾病分析

T. A. Garkusha, E. S. Stolyarevich, V. Khorzhevskii, S. V. Ivliev, M. Firsov
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The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p<0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. 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摘要

背景。包括肾脏肿瘤在内的恶性肿瘤在全球广泛存在。肾脏肿瘤的主要治疗方法是手术,其中一种是肾切除术。不同部位的恶性肿瘤可导致各种肾脏损害。各种原因引起的肾小球疾病通常没有症状,因此患者不会就医。为了诊断肾小球疾病,有必要通过免疫荧光反应和电子显微镜来评估形态学变化。目的:分析肾脏肿瘤中肾小球疾病的临床表现、频率和结构。研究包括 141 名患者。患者接受肾切除术,测定每日蛋白质流失量、尿液中红细胞数量变化、血清中肌酐水平,并计算肾小球滤过率(CKD-EPI)。样本的形态学评估包括免疫荧光反应和电子显微镜。为评估变量间关系的统计学意义,计算了斯皮尔曼非参数秩相关系数(Rs)。结果显示,P ˂ 0.05 时,结果具有显著性。41.8%的患者患有肾小球疾病。10.6%的患者患有肾小球肾炎,31.2%的患者患有糖尿病肾病。肾切除术前,肾小球肾炎患者的蛋白尿较高;手术治疗后,蛋白尿水平没有差异。肾切除术前,肾小球滤过率无明显差异;手术后,无肾小球病变的患者肾小球滤过率更高。一年后,肾小球病变患者的肾小球滤过率明显下降。在检查手术材料时,形态学专家还应评估肿瘤外肾组织的变化。建议由肿瘤学家和肾脏病学家共同管理患者。
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Analysis of glomerulopathies in kidney neoplasms
Background. Malignant neoplasms, including those of the kidneys, are widespread in the world. The main treatment for kidney tumors is surgery, one of its options is nephrectomy. Malignant tumors of various localizations can lead to a variety of kidney damage. Glomerulopathies of various origins are often asymptomatic, and therefore, patients do not seek medical help. For the diagnosis of glomerulopathies, it is necessary to assess morphological changes with the formulation of an immunofluorescence reaction and electron microscopy.The aim: to analyze the clinical manifestations, frequency and structure of glomerulopathies in kidney neoplasms.Patients and Methods. The study included 141 patients. The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p<0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies. CONCLUSION. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist Keywords: tumor, glomerulonephritis, diabetic nephropathy, glomerular filtration rate> ˂ 0.05.Results. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies.Conclusion. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist.
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