淀粉样变肾病73例临床病理研究

Clinicopathological Study on 73 Cases of Renal Amyloidosis

目的:研究淀粉样变肾病的病理变化及其临床意义。方法:对2 135例肾穿标本有淀粉样变肾病73例(3.42%)。进行光镜、免疫荧光和电镜观察并分析其临床关系。结果:继发性居多72.6%,其中移植肾2例。艾滋病(AIDS)2例。蛋白尿是主要症状(61/73),与肾小球基膜淀粉样沉积物密切相关(P<0.01)。光镜及免疫荧光观察病变常不典型,但电镜下,所有病例均可见特征性淀粉样纤维丝结构。结论:可疑病例应做肾穿活检,电镜是诊断依据。肾小球基膜淀粉样沉积物和病变是蛋白尿的主要形态学基础。移植肾和艾滋病有可能继发肾淀粉样变,应高度重视。

Objective: To study pathological changes and clinical significance of renal amyloidosis. Methods: 73 (3.42%) patients with renal amyloidosis from 2 135 kidney needle biopsy specimens were studied by light microscopy(CM), immunofluoreseence(IFM) and electron microscopy(EM). Results: Secondary amyloidosis was a common mode of presentation(72.6% ), and of these 73 cases, 2 cases of kidney transplant and 2 cases of AIDS were seen. Proteinuria (61/73) was closely correlated to amyloid deposits in glomerular basement membrane(P<0.01). There was special fibrils struture in all specimens for EM. Conclusion: Diagnosis by EM is a valuable standard for renal amyioidosis. Proteinuria is established on the morphologic basis of basement membrane changes. It is highly loossible that kidney transplant and AIDS are complicated by renal amyloidosis.