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目的:探讨肾淀粉样变性的病理特点,为临床诊断提供依据。方法:对2例肾病综合征患者行经皮肾穿刺活检术,所取组织分别进行组织学、免疫组织化学以及电镜检查。结果:光镜下观察结果:肾小球系膜区呈结节样改变,系膜区及内皮下见大量HE淡染的均质无细胞性物质沉积,间质小动脉管壁增厚,管壁内亦见HE淡染的均质沉积。刚果红及高锰酸钾刚果红染色均显示:肾小球系膜区、间质、间质动脉管壁阳性。免疫组织化学检测结果:2例IgG(±)、IgM(±)、IgA(-);1例C3c(-)、C4c(-)、C1q(-),1例C3c(±)、C4c(-)、C1q(-)。电镜下观察结果:肾小球系膜区无分支、紊乱排列的细纤维状结构。结论:淀粉样物质沉积于肾小球系膜区、间质及间质小动脉,使肾小球系膜区增宽,间质小动脉管壁增厚,刚果红染色阳性,高锰酸钾刚果红抵抗是肾淀粉样变性典型的病理特点。
Objective: To investigate the pathological features of renal amyloidosis and provide the basis for clinical diagnosis. Methods: Percutaneous renal biopsy was performed in 2 patients with nephrotic syndrome. Tissues, immunohistochemistry and electron microscopy were used to examine the tissues. Results: The results of light microscopy showed that the glomerular mesangial area showed nodular changes. In the mesangial area and in the endothelium, a large number of homogeneous cell-free material with light-stained HE staining and thickened walls of the interstitial arterioles were observed. The wall also see the homogeneous light deposition of HE deposition. Congo red and potassium permanganate Congo red staining showed: glomerular mesangial area, interstitial, interstitial arterial wall positive. The results of immunohistochemistry showed that there were two cases of IgG (±), IgM (±) and IgA (-), one case of C3c (-), C4c ), C1q (-). The results of electron microscopy: glomerular mesangial area without branching, disordered fine fibrous structure. Conclusion: Amyloid deposition in the mesangial area, interstitial and interstitial arterioles, the mesangial area widened, the thickening of the interstitial arterioles, Congo red staining positive, potassium permanganate Congo red resistance is a typical pathological feature of renal amyloidosis.