缺血性脑梗死与颈动脉斑块、嗜酸性粒细胞、血小板CD62p水平的临床相关性研究

目的探讨急性缺血性脑梗死初发与再发与颈动脉斑块、嗜酸性粒细胞水平与血小板活化水平之间的相关性。 方法本研究选取50例被诊断为急性缺血性脑梗死的患者,患者均进行颈部血管超声检查,根据有无颈动脉斑块分为2组,均进行嗜酸性粒细胞、血小板活性CD62p水平等指标检测。两组间比较采用t检验。 结果有颈动脉斑块形成的急性缺血性脑梗死患者,其嗜酸性粒细胞计数低于无颈动脉斑块患者（P < 0.05）,而其血浆CD62p水平高于无颈动脉斑块患者（P < 0.05）,1年随访中复发率更高（P < 0.05）。 结论急性缺血性脑梗死患者的初发与复发与颈动脉斑块存在,嗜酸性粒细胞计数及CD62p水平密切相关。     

TINU综合症一例讨论

肾小管间质性肾炎-眼色素膜炎综合症(TINU综合症)是一种少见的同时累及肾脏和眼的特发性疾病,以非少尿型急性肾衰和眼色素膜炎为突出表现,常无特异性病因,对糖皮质激素敏感。本文报道一例中年女性TINU综合症患者,眼色素膜炎先于肾病症状出现,经激素治疗有效。故认为对在眼科首诊的色素膜炎患者,不仅要早期予以激素治疗,还要仔细询问病史,完善相关辅助检查,以利全面诊断,及时处理问题。     

过敏性紫癜性肾炎肾组织中KIM-1的表达与临床意义

目的:探讨过敏性紫癜性肾炎肾组织中肾损伤分子1(kidney injury molecule 1,KIM-1)的表达与临床意义。方法:选择2015年4月到2018年1月在我院诊治的过敏性紫癜性肾炎患者150例作为研究对象,采用免疫组化法检测患者肾组织中KIM-1表达,采用半定量评分系统进行肾脏病理损害评分,并对二者进行相关性分析。结果:肾炎组织与肾旁组织的KIM-1相对表达量分别为(9.28±1.38)和(2.74±1.30),肾炎组织中KIM-1的表达显著高于肾旁组织(P=0.000);肾炎组织的毛细血管外肾小球活动、系膜增殖、内皮增殖、肾间质炎症、肾小球慢性化、肾小管间质慢性化指数评分均显著高于肾旁组织(P0.05);肾组织KIM-1表达量与肾小球慢性化指数、肾间质炎症指数、肾小管间质慢性化指数均呈显著正相关性(P0.05)。结论:过敏性紫癜性肾炎组织中KIM-1呈高表达,可能作为评估肾脏病理病变程度的参考指标。     

强壮粗体虫寄生引起的鳜肠道病理

强壮粗体虫是鳜肠道最常见寄生蠕虫。通过光镜及电镜对自然感染强壮粗体虫的鳜肠道进行了组织病理观察。强壮粗体虫的寄生引起鳜肠上皮细胞脱落、肠固有膜层结缔组织增生及白细胞向病灶处浸润,并可观察到嗜酸性粒细胞附着在与肠上皮及固有膜接触的虫体的体壁及吻部。在虫体吻部与肠固有膜层接触处依次观察到纤维细胞、成纤维细胞、嗜酸性粒细胞等,其中嗜酸性粒细胞又可分为未成熟嗜酸性粒细胞、成熟的嗜酸性粒细胞及正在脱颗粒的嗜酸性粒细胞。另外在肠壁的固有膜层观察到包裹虫体的结缔组织纤维囊,囊壁由三层结构构成,同时在鳜肠壁相同的位置观察到被宿主细胞浸润了的组织空腔,推测其为结缔组织纤维囊退化所形成       

沙漠干热环境猪肠管火器伤继发性肾损伤的病理学观察

目的:观察沙漠干热环境腹部肠管火器穿透伤后肾脏损害的病理学变化.方法:健康长白仔猪84头随机分为常温组及沙漠干热环境组.每组分为对照组、伤后1 h、2h、4h、8h、12h和24h组.建立腹部肠管火器穿透伤模型后,分别于伤后各时间点检测各组体温、伤道局部细茼学定量、血液细菌性培养定性、血清中内毒素水平;同时,切取肾组织进行病理组织学及超微结构观察.结果:两组动物均形成肠管穿孔伤,伤后各时间点体温逐渐升高,在相同时间点,沙漠组体温明显高于常温组(P<0.01);伤道血细菌培养:沙漠组伤后4h达到感染临界值与常温组具有显著性差异(P<0.01):8h血浆内毒素水平:沙漠组为0.970±0.04EU/ml与常温组0.63+0.08 EU/ml具有显著性差异(P<0.01).肾病理变化:沙漠组较常温组病变提前且随时间的延长呈进行性加重,以12h组-24h组出现肾小球变质性炎、肾小管急性坏死等病变.结论:沙漠环境腹部肠管火器穿透伤可造成肾损害,进行性发展为急性肾小球变质性炎和急性肾小管坏死,可能导致急性肾功能不全;血液动力学障碍及肠源性内毒素血症可能是肾损害的重要因素.     

趋化因子CCL-18 在慢性鼻- 鼻窦炎中的表达及意义

目的:分析趋化因子CCL-18在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜的表达差异,探讨CCL-18在慢性鼻-鼻窦炎中的表达及意义。方法:采用苏木精-伊红染色(HE),Masson染色及过碘酸-雪夫(PAS)染色对慢性鼻-鼻窦炎组织进行病理分析。采用Western blot检测CCL-18蛋白水平在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜组织中的表达差异。结果:CCL-18蛋白水平在伴鼻息肉和不伴有鼻息肉慢性鼻窦炎均较正常鼻黏膜组织中显著上调(P<0.05)。CCL-18蛋白水平在嗜酸性粒细胞慢性鼻窦炎的表达水平明显高于非嗜酸性粒细胞慢性鼻窦炎(P<0.05)。腺体型,纤维炎症型及水肿型慢性鼻-鼻窦炎中CCL-18表达水平均高于正常鼻黏膜,以水肿型表达最为显著(P<0.05)。结论:CCL-18在嗜酸性粒细胞和水肿型慢性鼻窦炎中高度表达,提示CCL-18可能参与慢性鼻-鼻窦炎中嗜酸性粒细胞的浸润这一基本病理过程。     

内源性逆转录病毒长末端重复序列在嗜酸性粒细胞增多症的基因表达及核苷酸序列分析

探索人内源性逆转录病毒长末端重复序列(LTR)基因及表达与嗜酸性粒细胞增多症发生的关系。PCR法检测嗜酸性粒细胞增多症患者外周血中内源性逆转录病毒长末端重复序列基因,RT-PCR法检测内源性逆转录病毒基因表达。变性高效液相分析和序列测定LTR片段核苷酸序列,对不同株基因序列作同源性的比较分析。PCR结果显示:20例嗜酸性粒细胞增多症患者细胞中均获得内源性逆转录病毒长末端重复序列扩增产物,嗜酸性粒细胞增多症组中长末端重复序列基因有高的表达,而正常人表达为阴性。与HERV-K家族LTR基因相应区域核苷酸序列比较;嗜酸性粒细胞增多组长末端重复序列U3、R、U5区同源性分析有核苷酸的改变,与淋巴瘤对照比较没有大片段的缺失。人类基因组中普遍存在逆转录病毒长末端重复序列。正常人和嗜酸性粒细胞增多症患者中长末端重复序列有不同程度核苷酸碱基的变异,但是,二者比较,这种改变与嗜酸性粒细胞的增多没有明显的相关性。在嗜酸性粒细胞增多症患者中有高的基因表达而正常人中没有可检出的病毒基因的表达,嗜酸粒细胞的增多可能与逆转录病毒基因表达水平有关,其诱导嗜酸粒细胞增多的机制需进一步的研究。     

微波快速石蜡切片技术及其在肾穿刺活检中的应用

肾穿刺活检技术推动了肾脏病理的迅速发展,使肾脏病理学整体知识不断更新和提高,为临床诊断和治疗提供了大量的依据.由于肾脏活检组织标本小、切片薄,在固定、脱水、透明、浸蜡、切片及染色等方面均与常规石蜡切片有所不同,其技术要求较高.肾穿刺石蜡切片时间较长,相对制约了急性肾功能衰竭、急进性肾炎、肾移植急性排斥反应等急重症的快速诊断.     

重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素

目的：通过研究重症急性肾损伤患者经连续性’肾脏替代治疗后肾功能恢复的影响因素,为重症急性肾损伤患者的诊治及预后提供科学依据。方法：选取2009年7月至2013年10月本院住院且采用CRRT治疗的284例重症急性肾损伤患者,记录患者的一般资料、APACHEII评分、血液生化指标、伴随症状及肾功能预后情况,将预后情况和各影响因素进行Logistic回归分析得出影响。肾功能恢复的影响因素。结果：284例重症急性肾损伤患者中,肾功能恢复有89例（31．33％）;肾功能恢复组的年龄、衰竭器官数、APACHEⅡ评分、动脉血二氧化碳分压、合并慢性肾脏病率及合并严重基础疾病率均低于肾功能未恢复组,而平均动脉压和血小板计数高于肾功能未恢复组（P〈0．05）,两组间合并机械通气率和合并少／无尿率无统计学差异（P〉0．05）;衰竭器官数、APAC—HEⅡ评分、合并严重基础疾病及AKl分期为CRRT治疗重症急性肾损伤患者肾功能恢复的危险因素。结论：CRRT治疗重症急性肾损伤的主要危险因素为衰竭器官数、APACHEⅡ评分、合并严重基础疾病及AKl分期。在临床治疗中,应正确评估病情,早期及时采取CRRT治疗,以提高生存率,促进肾脏功能恢复。     

过敏性紫癜兔模型的免疫学改变及机制初探

目的通过对过敏性紫癜兔模型免疫学改变的初步研究,探讨该病的免疫学发病机制。方法通过对过敏性紫癜兔模型进行血常规检测、ELISA方法检测免疫细胞及细胞因子CD3、CD4、CD8、CD4/CD8、IL-2、TNF-α含量;免疫荧光方法检测皮肤、肾脏免疫球蛋白IgA,IgG及补体C3;肾小球Masson染色、PAS染色;皮肤、肺组织的Luna染色等,并与对照组进行比较分析。结果与对照组相比,模型组兔血白细胞（WBC）增多,中性粒细胞（NEU）及百分比增高,嗜酸性粒细胞（EOS）及百分比增高,嗜碱性粒细胞增多等,差别均具有统计学意义;外周血CD3＋T淋巴细胞含量减少,CD4＋T淋巴细胞含量减少,CD8＋T淋巴细胞含量增多,CD4＋/CD8＋比值下降,细胞因子IL-2水平下降,TNF-α水平升高,差别均具有统计学意义;皮肤、肾脏免疫球蛋白IgA、IgG、C3表达增多;肾小球胶原纤维增生,系膜增厚,系膜基质增多;皮肤真皮层及肺组织内嗜酸性粒细胞表达增多。结论将为明确其发病机制,临床诊断和疗效观察找出新的指标,选择适当的治疗方案提供有价值的理论依据。     

Drug-induced acute interstitial nephritis: report of 10 cases.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.     

荧光假单胞菌感染大鲵的病理损伤

通过对感染荧光假单胞菌(Pseudomonas fluorescents)发病的大鲵(Andrias davidianus)主要器官进行病理剖解和病理组织学观察,以明确大鲵感染荧光假单胞菌引起的病理学损伤特点。结果表明,大鲵感染荧光假单胞菌后,主要表现为腹部极度膨胀、腹水和严重胃肠道反应,严重者可见将胃呕吐至口腔;组织器官具有典型的病理变化,其主要靶器官为肾、肝、肠道、皮肤和肌肉。分别引起坏死性肾小球肾炎、肝炎。此外,还可引起轻微肠炎及皮炎。可在肾小管管腔内、肝细胞坏死灶内、肠道固有层内及皮肤肌肉中发现数量极多的杆状细菌。     

Clinical Features of Severe Wasp Sting Patients with Dominantly Toxic Reaction: Analysis of 1091 Cases

Background

Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings.

Methods and Findings

A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting).

Conclusions

In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.     

TRAF1 improves cisplatin-induced acute kidney injury via inhibition of inflammation and metabolic disorders

BackgroundCisplatin-induced acute kidney injury (AKI) is a severe clinical complication with no satisfactory therapies in the clinic. Tumor necrosis factor receptor (TNFR)-associated factor 1 (TRAF1) plays a vital role in both inflammation and metabolism. However, the TRAF1 effect in cisplatin induced AKI needs to be evaluated.MethodsWe observed the role of TRAF1 in eight-week-old male mice and mouse proximal tubular cells both treated with cisplatin by examining the indicators associated with kidney injury, apoptosis, inflammation, and metabolism.ResultsTRAF1 expression was decreased in cisplatin-treated mice and mouse proximal tubular cells (mPTCs), suggesting a potential role of TRAF1 in cisplatin-associated kidney injury. TRAF1 overexpression significantly alleviated cisplatin-triggered AKI and renal tubular injury, as demonstrated by reduced serum creatinine (Scr) and urea nitrogen (BUN) levels, as well as the ameliorated histological damage and inhibited upregulation of NGAL and KIM-1. Moreover, the NF-κB activation and inflammatory cytokine production enhanced by cisplatin were significantly blunted by TRAF1. Meanwhile, the increased number of apoptotic cells and enhanced expression of BAX and cleaved Caspase-3 were markedly decreased by TRAF1 overexpression both in vivo and vitro. Additionally, a significant correction of the metabolic disturbance, including perturbations in energy generation and lipid and amino acid metabolism, was observed in the cisplatin-treated mice kidneys.ConclusionTRAF1 overexpression obviously attenuated cisplatin-induced nephrotoxicity, possibly by correcting the impaired metabolism, inhibiting inflammation, and blocking apoptosis in renal tubular cells.General significanceThese observations emphasize the novel mechanisms associated to metabolism and inflammation of TRAF1 in cisplatin-induced kidney injury.     

Sarcoidosis in Native and Transplanted Kidneys: Incidence,Pathologic Findings,and Clinical Course

Renal involvement by sarcoidosis in native and transplanted kidneys classically presents as non caseating granulomatous interstitial nephritis. However, the incidence of sarcoidosis in native and transplant kidney biopsies, its frequency as a cause of end stage renal disease and its recurrence in renal allograft are not well defined, which prompted this study. The electronic medical records and the pathology findings in native and transplant kidney biopsies reviewed at the Johns Hopkins Hospital from 1/1/2000 to 6/30/2011 were searched. A total of 51 patients with a diagnosis of sarcoidosis and renal abnormalities requiring a native kidney biopsy were identified. Granulomatous interstitial nephritis, consistent with renal sarcoidosis was identified in kidney biopsies from 19 of these subjects (37%). This is equivalent to a frequency of 0.18% of this diagnosis in a total of 10,023 biopsies from native kidney reviewed at our institution. Follow-up information was available in 10 patients with biopsy-proven renal sarcoidosis: 6 responded to treatment with prednisone, one progressed to end stage renal disease. Renal sarcoidosis was the primary cause of end stage renal disease in only 2 out of 2,331 transplants performed. Only one biopsy-proven recurrence of sarcoidosis granulomatous interstitial nephritis was identified.

Conclusions

Renal involvement by sarcoidosis in the form of granulomatous interstitial nephritis was a rare finding in biopsies from native kidneys reviewed at our center, and was found to be a rare cause of end stage renal disease. However, our observations indicate that recurrence of sarcoid granulomatous inflammation may occur in the transplanted kidney of patients with sarcoidosis as the original kidney disease.     

TLR9 Mediates Remote Liver Injury following Severe Renal Ischemia Reperfusion

Ischemia reperfusion injury is a common cause of acute kidney injury and is characterized by tubular damage. Mitochondrial DNA is released upon severe tissue injury and can act as a damage-associated molecular pattern via the innate immune receptor TLR9. Here, we investigated the role of TLR9 in the context of moderate or severe renal ischemia reperfusion injury using wild-type C57BL/6 mice or TLR9KO mice. Moderate renal ischemia induced renal dysfunction but did not decrease animal well-being and was not regulated by TLR9. In contrast, severe renal ischemia decreased animal well-being and survival in wild-type mice after respectively one or five days of reperfusion. TLR9 deficiency improved animal well-being and survival. TLR9 deficiency did not reduce renal inflammation or tubular necrosis. Rather, severe renal ischemia induced hepatic injury as seen by increased plasma ALAT and ASAT levels and focal hepatic necrosis which was prevented by TLR9 deficiency and correlated with reduced circulating mitochondrial DNA levels and plasma LDH. We conclude that TLR9 does not mediate renal dysfunction following either moderate or severe renal ischemia. In contrast, our data indicates that TLR9 is an important mediator of hepatic injury secondary to ischemic acute kidney injury.     

Renal Ischaemia Reperfusion Injury: A Mouse Model of Injury and Regeneration

Renal ischaemia reperfusion injury (IRI) is a common cause of acute kidney injury (AKI) in patients and occlusion of renal blood flow is unavoidable during renal transplantation. Experimental models that accurately and reproducibly recapitulate renal IRI are crucial in dissecting the pathophysiology of AKI and the development of novel therapeutic agents. Presented here is a mouse model of renal IRI that results in reproducible AKI. This is achieved by a midline laparotomy approach for the surgery with one incision allowing both a right nephrectomy that provides control tissue and clamping of the left renal pedicle to induce ischaemia of the left kidney. By careful monitoring of the clamp position and body temperature during the period of ischaemia this model achieves reproducible functional and structural injury. Mice sacrificed 24 hr following surgery demonstrate loss of renal function with elevation of the serum or plasma creatinine level as well as structural kidney damage with acute tubular necrosis evident. Renal function improves and the acute tissue injury resolves during the course of 7 days following renal IRI such that this model may be used to study renal regeneration. This model of renal IRI has been utilized to study the molecular and cellular pathophysiology of AKI as well as analysis of the subsequent renal regeneration.     

Renal failure associated with mucopolysaccharidosis type I in a cat from a MPS I research colony

Renal failure was diagnosed in an 11-mo-old male domestic shorthair cat from a colony with mucopolysaccharidosis type I lysosomal storage disease. Grossly, the kidneys were enlarged and bulged on cut section. Histology revealed tubular necrosis and regeneration with severe interstitial macrophage accumulation. Tubular epithelial cells and interstitial macrophages were distended by abundant, large cytoplasmic vacuoles. Electron microscopy demonstrated severe tubular epithelial vacuolar degeneration with lysosomes distended by granular debris and mineral precipitates. Interstitial macrophages contained similarly distended lysosomes. Although the initial cause of the tubular injury was not identified, the presence of macrophages laden with storage product most likely exacerbated the disease. The macrophage infiltrate may have caused tubular ischemia by compressing peritubular capillaries and separating tubules from their blood supply. Because the kidney is not normally affected in MPS I, this case is an unusual presentation of a well-characterized disease. Furthermore, this report documents the diagnostic workflow used to investigate a single case of feline acute renal failure in the setting of numerous at-risk laboratory animals.     

Chemokine receptor 5 blockade modulates macrophage trafficking in renal ischaemic-reperfusion injury

Chemokine receptor 5 (CCR5) is a pivotal regulator of macrophage trafficking in the kidneys in response to an inflammatory cascade. We investigated the role of CCR5 in experimental ischaemic-reperfusion injury (IRI) pathogenesis. To establish IRI, we clamped the bilateral renal artery pedicle for 30 min and then reperfused the kidney. We performed adoptive transfer of lipopolysaccharide (LPS)-treated RAW 264.7 macrophages following macrophage depletion in mice. B6.CCR5^−/− mice showed less severe IRI based on tubular epithelial cell apoptosis than did wild-type mice. CXCR3 expression in CD11b⁺ cells and inducible nitric oxide synthase levels were more attenuated in B6.CCR5^−/− mice. B6.CCR5^−/− mice showed increased arginase-1 and CD206 expression. Macrophage-depleted wild-type mice showed more injury than B6.CCR5^−/− mice after M1 macrophage transfer. Adoptive transfer of LPS-treated RAW 264.7 macrophages reversed the protection against IRI in wild-type, but not B6.CCR5^−/− mice. Upon knocking out CCR5 in macrophages, migration of bone marrow-derived macrophages from wild-type mice towards primary tubular epithelial cells with recombinant CCR5 increased. Phospho-CCR5 expression in renal tissues of patients with acute tubular necrosis was increased, showing a positive correlation with tubular inflammation. In conclusion, CCR5 deficiency favours M2 macrophage activation, and blocking CCR5 might aid in treating acute kidney injury.