糖尿病肾病单独和合并非糖尿病肾病的组织病理学和临床特征

S. M. Islam, Shamoli Yasmin, Ishtyiaque Ahmed, W. Haque
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引用次数: 0

摘要

背景与目的:糖尿病肾病(Diabetic nephropathy, DN)是糖尿病(DM)的主要并发症,也是导致终末期肾脏疾病的主要原因之一。本研究的目的是评估糖尿病患者DN和相关非糖尿病肾病(NDRD)的组织形态学和临床特征。材料与方法:研究于2019年7月至2020年12月在达卡武装部队病理研究所组织病理学部进行。来自已知糖尿病患者的肾活检样本被纳入研究。对福尔马林固定组织用红伊红(H&E)、周期性酸希夫(PAS)、马松三色(MT)和琼斯甲基胺银(JMS)染色。对组织进行IgG、IgA、IgM、C3、C1q、kappa和lambda染色,进行直接免疫荧光(DIF)检测。根据Tervaert分类系统对DN进行组织学分类。还进行了间质纤维化和小管萎缩(IFTA)以及小动脉透明化评分。从患者的信息表中检索临床信息。结果:共纳入46例DN病例活检标本。平均年龄46.76+10.63岁,男36例,女10例。最常见的临床表现为肾病范围蛋白尿(n=32, 69.56%)。其中有血尿27例(58.69%)。平均血清肌酐水平为4.28±2.61 mg/dl, 80.43%血清肌酐水平为bb0±1.5 mg/dl。组织病理学检查显示,III型DN 26例(56.5%),IV型DN 11例(23.9%)。IFTA得分1(50%)在7(15.2%)。血管透明化2分25例(54.3%),1分14例(30.4%),0分7例(15.2%)。DN II型、III型和IV型与高尿总蛋白(UTP)和血清肌酐水平相关。组织学变化中,肾小球硬化百分率、IFTA平均评分和血管透明化评分均以IV级DN最高,且与肾小球组织学分级均有显著相关性(p= <0.05)。非糖尿病肾病(NDRD) 21例(45.65%),以局灶节段性肾小球硬化(FSGS)最为常见(26.57%),其次为IgA肾病和感染后肾小球肾炎(PIGN)。46例患者中包括一例移植后活检,显示II型DN并伴有钙调磷酸酶抑制剂毒性特征。结论:Tervaert对本组病例的组织学分类显示,ⅲ类DN病变占主导地位,其分类与患者年龄、血清肌酐水平、平均IFTA、小动脉透明化和NDRD有显著相关。在NDRD中,FSGS是最常见的病理。中华医学会医学杂志。2023;17(1): 003。DOI: https://doi.org/10.55010/imcjms.17.003*Correspondence: Sk Md Jaynul Islam,组织病理学部门,武装部队病理学研究所,达卡营地,孟加拉国达卡。电子邮件:jaynul.islam@gmail.com
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Histopathologic and clinical features of diabetic nephropathy alone and with concomitant nondiabetic renal diseases
Background and objective: Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM) and one of the leading causes of end-stage kidney disease. The aim of the present study was to evaluate the histomorphological and clinical profiles of DN and associated non-diabetic renal dieases (NDRD) in diabetic patients. Materials and methods: The study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka, from July 2019 to December 2020. Renal biopsy samples from known diabetic patients were included in the study. The formalin-fixed tissues were stained with haematoxylene & eosin (H&E), Periodic acid Schiff (PAS), Masson Trichrome (MT) and Jones Methanamine Silver (JMS) stains. Tissues were stained for IgG, IgA, IgM, C3, C1q, kappa and lambda for direct immunofluorescence (DIF) study. DN was histologically classified according to Tervaert classification system. Interstitial fibrosis and tubular atrophy (IFTA) as well as arteriolar hyalinization scoring was also done. Clinical information was retrieved from the patient’s information sheet. Results: Total 46 biopsy samples from DN cases were included in the study. The mean age of the cases was 46.76+10.63 years, including 36 males and 10 females. The most common clinical presentation was nephritic range proteinuria (n=32, 69.56%). Among all, 27 (58.69%) patients had haematuria. The mean serum creatinine level was 4.28+2.61 mg/dl, and 80.43% had serum creatinine levels >1.5 mg/dl. Histopathologic examinatiom revealed type III DN in 26 (56.5%) and type IV DN in 11 (23.9%) cases. IFTA score 1 (<25%) was seen in 20 (43.5%), score 2 (25-50%) in 19 (41.3%) and score 3 (>50%) in 7 (15.2%). Vascular hyalinization score-2 in 25 (54.3%), score-1 in 14 (30.4%) and score-0 in 7 (15.2%). DN class II, III and IV were associated with high urinary total protein (UTP) and serum creatinine levels. Among the histologic changes, percentage of glomerular sclerosis, the mean IFTA score and vascular hyalinization score were found to be highest in class IV DN, and all were significantly associated with histologic glomerular DN classes (p= <0.05). Of the total cases, 21 (45.65%) were found with nondiabetic renal diseases (NDRD), the most common feature was focal segmental glomerulosclerosis (FSGS) (26.57%), followed by IgA nephropathy and post-infectious glomerulonephritis (PIGN). Among 46 cases, one post-transplant biopsy was included, which revealed class II DN along with features of calcineurin inhibitor toxicity. Conclusion: Tervaert’s histologic classification of our cases revealed class III DN lesions as the predominant one, and the classes had a significant association with age of the patient, serum creatinine level, mean IFTA, arteriolar hyalinization and NDRD. Among the NDRD, FSGS was the most common pathology. IMC J Med Sci. 2023; 17(1): 003. DOI: https://doi.org/10.55010/imcjms.17.003 *Correspondence: Sk Md Jaynul Islam, Department of Histopathology, Armed Forces Institute of Pathology, Dhaka Cantonment, Dhaka, Bangladesh. Email: jaynul.islam@gmail.com
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