Morphometry: assessing direct and indirect methods of measuring the diameters of tubular structures / Morfometría: evaluación de métodos directos e indirectos para medir los diámetros de las estructuras tubulares

SUMMARY: Knowledge of the diameter of a structure or particle is required for stereological calculations. However, there is no consensus on the methodology for its measurement. This study aims to assess the differences between direct and indirect methods of measuring diameter. It is hypothesised that kidneys were removed, fixed, processed, sectioned, and stained. The stained slides were imaged using a digital microscope. The images were processed using the ImageJ software. The diameters of the renal glomeruli and collecting tubules were measured using direct and indirect methods. The measured diameters were analysed using the SPSS software v20. The differences between the measurements were assessed using a Z-test and test of association, and P < 0.05 was considered significant. No significant differences were observed between the diameters of the glomeruli (P = 0.82) and proximal (P = 0.86) and distal (P = 0.55) convoluted tubules as measured via direct and indirect methods. There was a strong positive correlation between the diameters of glomeruli (P = 0.97) and proximal (P = 0.82) and distal (P = 0.93) convoluted tubules measured using the two methods, both of which are convenient, accurate and suitable. The P-values based on these measurements were more than 0.05. Therefore, the study hypothesis was rejected. There was no significant difference between the direct and indirect methods of measuring diameter, and the null hypothesis was rejected; thus, both methods can be applied either independently or jointly.

RESUMEN: Se requiere el conocimiento del diámetro de una estructura o partícula para los cálculos estereológicos. Sin embargo, no existe consenso sobre la metodología para su medición. Este estudio tuvo como objetivo evaluar las diferencias entre los métodos directos e indirectos de medición del diámetro de una estructura. Riñones de ratas Wistar fueron extirpados, fijados, procesados y seccionados, y luego se tiñeron con HE. Se tomaron imágenes de las muestras teñidas usando un microscopio digital. Las imágenes fueron procesadas utilizando el software ImageJ. Los diámetros de los glomérulos renales y túbulos colectores se midieron por métodos directos e indirectos. Los diámetros medidos se analizaron utilizando el software SPSS v20. Las diferencias entre las medidas se evaluaron mediante una prueba Z y una prueba de asociación, y se consideró significativa P < 0,05. No se observaron diferencias significativas entre los diámetros de los glomérulos (P = 0,82) y túbulos contorneados proximales (P = 0,86) y distales (P = 0,55) medidos mediante métodos directos e indirectos. Hubo una fuerte correlación positiva entre los diámetros de los glomérulos (P = 0,97) y los túbulos contorneados proximales (P = 0,82) y distales (P = 0,93) medidos con los dos métodos, ambos convenientes, precisos y adecuados. Los valores P basados en estas mediciones fueron superiores a 0,05. Por lo tanto, se rechazó la hipótesis del estudio. No hubo diferencia significativa entre los métodos directo e indirecto de medición del diámetro, y se rechazó la hipótesis nula; por lo tanto, ambos métodos se pueden aplicar de forma independiente o conjunta.

Comparison of clinical characteristics of diffused capillary endothelial proliferative Henoch?Schonlein purpura nephritis children with or without crescents formation / 中国综合临床

Objective To compare the clinical features of diffuse capillary endothelial proliferative Henoch-Schonlein purpura nephritis ( DEP-HSPN ) with or without crescent formation. Methods The clinical data of 110 children with DEP-HSPN admitted to Dalian Central Hospital and the First Affiliated Hospital of Dalian Medical University from January 2008 to January 2018 were analyzed retrospectively. Among them,24 cases were divided into non crescentic group and 86 cases into crescentic group. The clinical characteristics and prognosis of the two groups were statistically analyzed. Results The clinical manifestations of children without crescent body formation group were all type III. There were 35 cases of type III and 51 cases of type V in the crescent body formation group. Compared with non-crescent formation group,the proportion of gross hematuria(83. 7%(72／86) vs. 29. 2%(7／24),χ2＝10. 396),urine red blood cell count ((112. 4±20. 3)／HP vs. (45. 2±10. 6)／HP,t＝9. 697),24 h urine protein ((2471. 6 ±242. 0) mg／d vs. (1358. 5±109. 3) mg／d,t＝6. 372) and serum creatinine (( 44. 9 ± 9. 6) μmol／L vs. (32. 3±5. 2) μmol／L,t＝5. 390) increased significantly,the serum albumin (( 22. 8±3. 8) g／L vs. ( 35. 1 ±5. 7) g／L,t＝4. 806)decreased significantly (all P＜0. 05). Both groups had non-simple IgA deposits in the mesangial region. The proportion of complete remission and asymptomatic hematuria was 70. 8%( 17／24) and 29. 2%( 7／24) in the non-crescent group, 58. 1%( 50／86) and 41. 9%( 36／86) in the crescent group,respectively,with no significant difference ( χ2＝1. 330,1. 196, all P＞0. 05) . Conclusion When DEP-HSPN is accompanied by crescent formation, gross hematuria, urinary erythrocyte count and the proportion of massive proteinuria increase significantly. Combined immunosuppressive therapy in acute stage and long-term sequential treatment in remission stage can achieve good prognosis.

Cystic kidney disease in children / 中华实用儿科临床杂志

Both the incidence and prevalence of chronic kidney disease are rising rapidly all over the world, which brings heavy economic and mental burden to the patients and the society. A retrospective study of the European Renal Association _ European Dialysis and Transplant Association( ERA _ EDTA) Registry showed cystic kidney disease was one of the three most prevalent rare diseases leading to renal replacement therapy before the age of 20 years. Renal cystic disease encompasses a variety of diseases that cause single or multiple cysts in the kidneys,and can be divided into 3 categories:cystic kidney disease due to fetal renal malformations,hereditary cystic kidney diseases and acquired cystic kidney diseases. Acquired renal cysts rarely occur in the general pediatric population. Renal cystic disease can present during fetus,infancy,childhood or adulthood. The onset of the disease is occult,and the clinical manifestations are heterogeneous. The manifestations may be confined to the kidney or as part of a syndrome. On renal imaging,the kidney size is normal,enlarged or small,and cysts can involve unilateral or bilateral kidneys. Pamily history investigation should be performed when collecting first_hand clinical data. Genetic testing can confirm the diagnosis of hereditary renal cystic disease. Cystic kidney disease is currently treated symptomatically,and patients with end_stage renal disease require renal replacement therapy.

Pattern of Glomerular Disease in Patients with Nephrotic Syndrome- A Single Centre South Indian Study.

Background: The prevalence of primary and secondary glomerular diseases presenting as nephrotic syndrome (NS) varies according to the demography, renal biopsy practice and geographic location. To determine the morphological patterns of glomerular lesions in renal biopsies from patients manifesting with NS, in our local (South Indian) population. Methods: The study was conducted in a tertiary care hospital in South India between 2008 and 2014 on adults and children presenting with NS. Renal biopsies were performed in all patients and subjected to light microscopic and immunofluorescence studies. Results: A total of 264 cases of NS were identified of which 80.7% were adults and 19.3% were children. The mean age for the adults was 42.2 years with a male: female ratio of 1.6:1 and the mean age for children was 12.1 with a male: female ratio of 1.8:1. The most common cause of NS in adults was minimal change disease (MCD) (42.7%) followed by membranous nephropathy (MN) (24.4%) and focal segmental glomerulo-sclerosis (FSGS) (17.8%). In children MCD (88%) was the single most common cause of NS followed by FSGS (5.9%) and MN (3.9%). Compared to MCD and MN, a higher incidence of microscopic haematuria and renal insufficiency was present in FSGS. Conclusion: A wide range of primary and secondary glomerular disorders can present as NS, the prevalence of which varies according to the geographic area and demography. Though the frequencies of MCD, MN, and FSGS in our study were different from other studies conducted in India and other countries, these three glomerular disorders are the three major causes of NS in many geographic areas across the world.

Renal corpuscles were protected from dichlorvos: induced morphological alterations in rats by antioxidant vitamins / Protección de corpúsculos renales ante alteraciones morfológicas inducidas por el diclorvos en ratas mediante el uso de vitaminas antioxidantes

Dichlorvos (DDVP), an organophosphorus pesticide is a volatile compound which enters the human body through oral, dermal and inhalational routes and is excreted via the kidney. This study assessed the effects of DDVP on the histology of the kidney. Twenty five male rats (75.05 ± 5.55 g) were divided into 5 groups of 5 rats per group as follows: Unexposed group, exposure to DDVP alone for 5 weeks, and 3 other groups exposed to DDVP for 5 weeks in addition to supplement with Vitamin E, vitamin C, and red palm oil (RPO). Rats were exposed to DDVP in poorly ventilated cardboard cages for 4 hours daily. On completion of exposure, rats were euthanized and tissue processed by routine paraffin wax method and stained with H&E. Morphological alterations monitored by histological and morphometric studies using the graticule and software packages. Data were analyzed with ANOVA and p<0.05 considered as significant. DDVP caused significant reduction (10%) in the maximum glomerular diameter and 18% reduction in the maximum width of the renal corpuscle when compared with unexposed rats. However, VTE, VTC, and RPO significantly elevated the maximum glomerular diameter by 21%, 22%, 23% the respectively. Similarly, VTE, VTC, and RPO significantly elevated the maximum width of the renal corpuscle by 17%, 19%, 20% respectfully. Glomerular tuft cellularity was neither affected by DDVP treatment nor by vitamin augmentation. Inhaled DDVP caused histological alterations in the microscopic anatomy of renal corpuscles of rat which was mitigated by vitamin supplementation. Data suggest involvement of prolonged DDVP use in the aetiology of renal failure.

El diclorvos (DDVP), un pesticidas organofosforado, es un compuesto volátil que entra en el cuerpo humano a través de la vía oral, dérmica y por rutas inhalación, excretándose por vía renal. Este estudio evaluó los efectos histológicos del DDVP sobre el riñón. Veinticinco ratas machos (75,05±5,55 g) se dividieron en 5 grupos de 5 ratas cada uno: grupo no expuesto, expuesto a DDVP durante 5 semanas, y otros 3 grupos expuestos a DDVP durante 5 semanas, suplementados con vitamina E (VTE), vitamina C (VTC) y aceite de palma roja (APR). Las ratas fueron expuestas a DDVP en jaulas de cartón con poca ventilación por 4 horas diarias. Al término de la exposición, las ratas se sacrificaron y el tejido fue procesado para inclusión en parafina y tinción con H&E. Las alteraciones morfológicas se evaluaron mediante estudios histológicos y morfométricos utilizando retículas y software. Los datos se analizaron con la prueba ANOVA considerado un p<0,05 como significativo. El DDVP causó una reducción significativa (10%) en el diámetro máximo glomerular y ancho máximo del copúsculo renal (18%), en comparación con las ratas no expuestas. Sin embargo, el diámetro máximo glomerular fue significativamente elevado con VTE, VTC y APR en 21%, 22% y 23%, respectivamente, así como para el ancho máximo del corpúsculo renal por 17%, 19% y 20%, respectivamente. La celularidad de la red glomerular no fue afectada por el DDVP ni aumentó con el tratamiento de vitamina. El DDVP inhalado provocó alteraciones histológicas en la anatomía microscópica de los corpúsculos renales de rata, las que fueron mitigadas por la suplementación de vitamina. Los datos sugieren relación entre la exposición prolongada a DDVP y la etiología de la insuficiencia renal.

Analysis of epidemiological characteristics and pathological types of 1 645 renal biopsy data / 临床与实验病理学杂志

Abtract:Purpose To analyze epidemiological characteristics and pathological types of 1 645 renal biopsies in Jiangsu province. Methods The reports of 1 654 percutaneous renal biopsies performed from January 2009 to June 2013 were retrospectively analysed . Results 1 597 out of 1 645 renal patients were successfully biopsied with a success rate of 97. 1%. Primary glomerular diseases ac-counted for 78. 56% of the total patients, secondary glomerular diseases 18. 71%. IgA nephropathy and mesangial proliferative lession accounted for high percent of primary glomerular diseases. Lupus nephritis was the most frequent pathologic type of secondary glomeru-lar diseases, followed by allergic purpura nephritis and diabetic nephropathy. Mesangial proliferative glomerulonephritis and hyperten-sive renal injury were more common in the Southern than in the Northern Jiangsu province, while acute tubular necrosis and allergic purpura nephritis were less in the Southern Jiangsu province. Conclusions Primary glomerular disease is still the most frequent glo-merular diseases in Jiangsu province, among which the IgA nephropathy was predominated. In secondary glomerular disease, lupus ne-phritis is the most frequent pathological type. The incidences of kidney diseases have geographical variation.

Commentary: Is the Evidence for Localization of Nephrin on the Slit Diaphragm Rigid? / Comentario: ¿Está la Evidencia para la Localización de Nefrina en el Diafragma de Ranura Rígido?

After careful observation of immuno-electron microscopic findings of the renal glomerular podocyte slit so far published by various authors, it should be noted that no convincing evidence is present for localization of nephrin-immunoreactivity in the slit itself, but that nephrin-immunoreactivity is dominantly localized along the membranes of podocyte pedicles from their tip over a substantial extension. In addition, the notion that the slit diaphragm is composed of strands is compatible with the widely distributed view that the slit strands represent rod-shaped nephrin molecules. However, 3-D findings that the diaphragm is composed of not only strands but also membranous elements have recently demonstrated separately by embedment-free section electron microscopy as well as by frozen/deep-etched replica electron microscopy. It is therefore suggested that the molecular composition of the slit diaphragm remain to be further elucidated, and that it is also necessary to re-consider how nephrin is involved in the renal glomerular filtration based on the exact localization along the podocyte membrane, but not in the slit itself. The present author would welcome any criticism and opinion on his consideration.

Después de una cuidadosa observación de los hallazgos inmunoquímicos, vía microscopio electrónico, de la hendidura del podocito glomerular renal ampliamente publicados por varios autores, se debe hacer notar que no existe evidencia convincente de la presencia de inmunorreactividad de nefrina en la hendidura propiamente tal, ya que la inmunorrectividad de nefrina está predominantemente localizada a lo largo de la membrana de los podocitos desde su extremo sobre una sustancial extensión. Agregado a ello, la idea de que el diafragma de la hendidura está compuesto de filamentos es compatible con la visión que los filamentos diafragmáticos representan moléculas de nefrina en forma de varilla. Sin embargo, hallazgos en 3D muestran que el diafragma está compuesto no solamente de filamentos sino que también por elementos membranosos que han sido demostrados recientemente por sección libre de microscopía electrónica (embedment-free), así como también por microscopía electrónica de réplica por congelación y grabado profundo (frozen/deep-etched). Por lo tanto, se ha sugerido que la composición molecular del diafragma de filtración permanece para ser estudiada en el futuro y que es también necesario reconsiderar como la nefrina está involucrada en la filtración glomerular renal basados en la localización exacta a lo largo de la membrana del podocito pero no en la hendidura misma. A los autores les gustaría recibir alguna crítica u opinión sobre su consideración.

El desbalance glomérulo-tubular en la fisiopatología de la hipertensión arterial asociada al bajo peso al nacer / Glomerular-tubular imbalance in the pathophysiology of the arterial hypertension associated with low birth weight

La hipertensión arterial constituye un problema de salud mundial. Quedan sin esclarecer mecanismos fisiopatogénicos en su aparición. Se ha asociado el bajo peso al nacer por crecimiento intrauterino retardado con la hipertensión en la edad adulta, relacionado con nefrogénesis incompleta. El desarrollo de hipertensión en ratas, provocando hipertrofia tubular proximal, indica que el desbalance entre las funciones glomerular y tubular genera incapacidad excretora del riñón y esta podría existir en el daño renal del bajo peso. Con el objetivo de valorar la posible implicación del desbalance glomérulo-tubular a preponderancia tubular en los mecanismos fisiopatológicos renales descritos en la hipertensión asociada al crecimiento intrauterino retardado, se utilizaron métodos teóricos. El cuerpo teórico elaborado se fundamentó en datos consultados en revistas científicas. Se concluye que el estado de desbalance glomérulo-tubular con preponderancia tubular, ha sido poco estudiado en relación con el desarrollo de la hipertensión en estos sujetos. Este fenómeno no se reconoce, hasta el momento, como una «anormalidad¼ renal, que puede constituir un mecanismo hipertensógeno primario.

High blood pressure (hypertension) is a global health problem. Pathophysiologic mechanisms are unclear in their appearance. Reports have linked low birth weight and intrauterine growth retardation with hypertension in adulthood, related to incomplete nephrogenesis. The development of hypertension in rats leading to proximal tubular hypertrophy indicates that the imbalance between glomerular and tubular functions generates excretory kidney failure and it could be in renal damage of the low weight. In order to assess the possible involvement of glomerular-tubular imbalance with tubular preponderance, within pathophysiological renal mechanisms described in hypertension associated with intrauterine growth retardation, theoretical methods were used. The theoretical framework developed was based on data accessed in scientific journals. We conclude that the state of glomerular-tubular imbalance with tubular preponderance has been little studied in relation to the development of hypertension in these subjects. This phenomenon is not recognized, so far as «abnormal¼ renal, which may be a primary hypertensogenous mechanism.

Alterações renais gênero-dependentes em ratos com insuficiência renal crônica / Gender-dependet renal alterations in rats with chronic renal failure

A insuficiência renal crônica (IRC) é caracterizada por alterações glomerulares secundárias aos mecanismos adaptativos ocasionados por perda de néfrons funcionantes. Alterações na hemodinâmica glomerular, proliferação celular, influxo de células inflamatórias, desequilíbrio na síntese de proteínas da matriz extracelular glomerular (MECG) e perda da seletividade de carga e/ou tamanho da membrana basal glomerular têm sido apontados como mecanismos envolvidos na expansão mesangial e conseqüente glomeruloesclerose. A participação dos hormônios sexuais na função renal e na evolução da insuficiência renal crônica tem sido sugerida. Os glicosaminoglicanos, especialmente o heparan sulfato (HS), têm sido associados à seletividade glomerular de macromoléculas. O remodelamento podocitário precoce e a proteinuria (PTN) se relacionam com a progressão da IRC. Neste contexto, o acúmulo de MECG, proliferação de miofibroblastos e PTN têm sido apontados como mediadores precoces que precedem as lesões glomerulares e túbulo-intersticiais. Neste estudo, avaliamos as alterações renais precoces (30 dias de IRC) gênero-dependentes em ratos (M) e ratas (F) Wistar submetidos à redução de 5/6 da massa renal (IRC) e à castração (c). Os animais foram divididos em 10 grupos: Controles (C) (CM, CF, CMc, CFc) e sham (CM sham, CF sham); e aqueles submetidos à nefrectomia 5/6: IRCM, IRCF, IRCMc, IRCFc. Os animais foram castrados com 5 semanas e submetidos à nefrectomia 5/6 com 7 semanas de idade. Resultados significativos mostraram que os machos com IRC apresentaram maior PTN, acompanhada de maior comprometimento mesangial, imunomarcação positiva para α-actina e maior concentração de heparan sulfato (HS) comparados com as fêmeas IRC (p<0,05). Estas alterações foram reduzidas nos machos castrados. A análise da morfologia podocitária mostrou raras regiões onde ocorreram alterações podocitárias nos grupos IRC. O conjunto de dados sugere que o hormônio masculino pode participar na manutenção...

Chronic renal failure (CRF) is characterized by adaptive mechanisms secondary to the loss of functioning nephrons. Glomerular hemodynamics alterations, cellular proliferation, inflammatory cells influx, imbalance between synthesis and degradation of the glomerular extracellular matrix (GECM) and loss of charge and/or size selectivity of the glomerular basal membrane are pointed as mechanisms leading to mesangial expansion and glomerulosclerosis. Additionally, participation of gender related hormones on renal function and progression of CRF have been suggested. We evaluated the effect of castration in renal alterations in males (M) and females (F) Wistar rats, after 30 days of 5/6 reduction of renal mass (CRF). The animals were castrated (c) at 5 weeks old and 7 weeks old 5/6 and sham nephrectomy were done. Groups: Control (C) CM, CM sham, CMc, CF, CF sham, CFc, CRFM, CRFMc, CRFF, CRFFc. CRFM group showed higher proteinuria followed by increased mesangial expansion and α-actin immunostaining. Concomitant higher concentration of heparan sulfate (HS) was also observed when compared to CRFF (p<0.05). These alterations were reduced in CRFMc group. Podocyte morphology analysis through electronic microscopy showed few disorders of foot processes in CRF groups Overall, CRFF group showed fewer alterations compared to males, and a reduction of HS was observed in association with PTN. Castration did not change this profile in female rats. Data suggest that male hormones may participate in the maintenance of the mesangial equilibrium and that PTN collaborated with the mesangial expansion process. Additionally, the higher concentration of HS in CRFM suggest that the remodeling process of the GECM, included a synthesis of de novo HS, that presented a functioning defect, compromising the glomerular filtration barrier and, ultimately corroborated with the loss of its selectivity and consequently with a higher PTN. This set of results leads us to conclude that PTN appears...

Efectos de la ingestión crónica de etanol sobre las características histológicas del riñón de ratas machos adolescentes / Effects of chronic ingestion of ethanol on the histological features of the adolescent male rats' kidney

Se pretende conocer los efectos del alcoholismo crónico durante la adolescencia sobre las características histológicas del riñón en ratas. Se emplearon 42 ratas machos de 30 días de vida posnatal con las cuales se conformaron 2 grupos de 21 animales cada uno, tratados durante 3 y 5 meses y con cada grupo, 2 subgrupos: experimental (E) y control (C). A las ratas del grupo E se les suministró etanol a una dosis de 5/kg de peso corporal y al grupo C se le suministró agua, ambos mediante cánula intraesofágica. Al final del experimento se extrajeron ambos riñones y se obtuvieron cortes histológicos que se colorearon con hematoxilina y eosina. Se observó que las ratas del grupo experimental de 3 meses presentaron glomérulos hipertrofiados y algunos esclerosados con signos de hialinosis, así como corpúsculos con discontinuidad de la hoja parietal. Muchos túbulos renales presentaron aumento de la luz y signos de tubulorrexis. Las ratas de 5 meses presentaron glomeruloesclerosis focal colapsante con disminución de la talla glomerular y gran amplitud del espacio capsular. Algunos glomérulos presentaron signos de infiltración leucocitaria y material hialino. Se observaron túbulos renales muy dilatados, algunos mostraron pared con epitelio simple plano, material acidófilo en la luz y signos de tubulorrexis. Se concluye que la ingestión de altas dosis de etanol provocó alteraciones histológicas severas a nivel de los glomérulos y túbulos renales

We intended to know the effects of chronic alcoholism during the adolescence on the histological features of rats' kidney. In study were included 42 male rats of 30 days of postnatal life divided into two groups of 21 animals each treated over 3 and 5 months and with each group, 2 subgroups: experimental (E) and control. The E group rats received ethanol in a dose of 5/kg of body weight and C group received water, both by intraesophageal cannula. At the end of experiment both kidneys were removed with histological sections stained with hematoxylin and eosin, as well as corpuscules with a lack of continuity of parietal folium. Many renal tubules showed a lumen increase and signs of tubulorrhexis. The 5 months of life had collapsing focal glomerulosclerosis with a decrease of glomerular size and large amplitude of capsular space. Some glomeruli had signs of leukocyte infiltration and hyaline material. There were renal tubules very dilated, some showed a wall with simple epithelium, acidophilic material by light and signs of tubulorrhexis. We conclude that ingestion of high doses of ethanol provoked severe histological alterations at level of glomeruli and renal tubules

Mecanismos fisiopatológicos del desbalance glomérulo-tubular en la hipertensión arterial / Pathophysiological mechanisms of the lack of glomerulus-tubule balance in arterial high blood pressure

Las actuales tendencias e hipótesis para interpretar los mecanismos etiopatogénicos de la hipertensión arterial esencial, involucran al sistema renal como mecanismo preponderante en la regulación a largo plazo de la presión arterial y la existencia en él de algún fenómeno que puede conllevar a desbalance glomérulo-tubular, con preponderancia tubular Aunque el análisis de este último hecho no ha sido como tal abordado en la patogénesis del síndrome hipertensivo. Con el objetivo de interpretar el papel del desbalance glomérulo-tubular, con preponderancia tubular en la fisiopatología de la hipertensión arterial como fenómeno en el que confluyen múltiples mecanismos fisiopatológicos renales ya descritos, se revisaron estos últimos, de forma integrada y su relación causal con el desbalance glomérulo-tubular, con preponderancia tubular. La preponderancia tubular, punto común de los mecanismos que se discuten, favorece la disminución de la excreción fraccional de Na+, la retención hidrosalina y la elevación de la presión arterial

The current trends and hypotheses to know the etiopathogenesis mechanisms of the essential arterial high blood pressure involved the renal system as a prevailing mechanism in the long-term regulation of arterial pressure and the existence in it of some phenomenon that could lead to a glomerulus-tubule lack of balance with tubular preponderance. Although the analysis of this latter fact, has not been approached as such in pathogenesis of hypertensive syndrome. With the aim of to interpret the role of glomerulus-tubule lack of balance with tubular preponderance in pathophysiology of arterial high blood pressure as a phenomenon in which converging multiple renal pathophysiological mechanisms already described, these latter were reviewed in a integrated way and its causal relation with the above mentioned lack of balance with tubular preponderance. This preponderance, a common point of discussed mechanisms, favors the decrease of a fractional releasing of Na+, the hydrosaline retention and the raise of arterial pressure

Glomérulo esclerosis focal y segmentaria. Trasplante renal y plasmaféresis / Focal segmental glomerulo sclerosis renal transplant and plasmapheresis

La Glomérulo Esclerosis Focal y Segmentaria (GEFS) primaria es una entidad que se define histológicamente por el depósito de material hialino en los glomérulos renales. Su origen permanece aún desconocido y es una de las causas más importantes del Síndrome Nefrótico (SN) Corticorresistente. La GEFS es la causa diagnostica de base del 8,3 por ciento de los casos de Insuficiencia Renal Crónica (lRC), del 14 por ciento de pacientes en plan de diálisis y del 13,5 por ciento de los receptores de Trasplante Renal. Además, luego del trasplante renal, esta enfermedad tiene una tasa elevada de recaída sobre el injerto. Sobre la fisiopatología de esta enfermedad, las últimas líneas teóricas hacen hincapié en la función de los podocitos, estos datos surgieron del conocimiento de alteraciones genéticas que implican a estas células. La hipótesis de que un "factor plasmático circulante" aumenta la permeabilidad de los glomérulos a la albumina está apoyada en numerosos estudios clínicos y experimentales. Esta es la base fisiopatológica del tratamiento donde se encuentra ubicada como uno de los pilares la Plasmaféresis, acompañando a las nuevas modalidades de Inmunosupresión. Esta revisión está focalizada en los mecanismos fisiopatológicos involucrados en esta enfermedad y a describir las terapéuticas utilizadas en su tratamiento.

Primary focal segmental glomerulosclerosis (FSGS) is an entity defined in histological terms by the hyaline material depot that is found in renal glomerulus. Its origin still remains unknown and it's one of the most important causes of corticosteroid-resistant nephrotic syndrome. FSGS is the main diagnostic cause of: 8.3 per cent of chronic renal failure (CRF) cases, 14 per cent of dialysis patients and 13.5 per cent of people receiving a kidney transplant. Besides, after the renal transplantation, this disease has a high rate relapse over the graft. Concerning the pathophysiology of FSGS, the latest theoretical research emphasizes on the podocytes function. These data came out from the knowledge of the genetic disorder that these cells implicate. The hypothesis that a "plasmatic circulating factor" increases the permeability of the glomerulus for albumin is supported by both several clinical and experimental research. The plasmatic circulating factor is the pathophysiological base for the treatment whit plasmapheresis along whit immunosuppression procedures. This present revision is focused on the pathophysiological mechanisms involved in, and des­cribes the therapies used on its treatment.

Radiation nephritis: anti-inflammatory effect of dexamethasone in adult Wistar rats (Rattus norvegicus) / Nefritis por radiación: efecto anti-inflamatorio de la dexametasona en ratas Wistar adultas (Rattus norvegicus)

The anti-inflammatory effect of dexamethasone on the irradiated kidneys of adult Wistar rats (Rattus norvegicus) was studied. Eighteen adult Wistar rats were, after acclimatization, randomly divided into 3 groups of 6 animals per group. The control group had normal saline, receiving neither drugs nor radiation. The second group received normal saline and radiation. The third group received pretreatment with dexamethasone at 1mg/kg body weight/day for 2 days followed by radiation. Radiation was delivered to the animals as a single fraction of 2.5 Gy of gamma rays from Cobalt-60 source, using an AECL Theatron 780-C Teletherapy machine. After exposure to the different interventions, the animals were sacrificed on the 14th post-irradiation day and the kidneys dissected out from each animal. The renal tissues were subjected to histological processing, and then studied using an eyepiece objective ruler calibrated with a 2mm stage micrometer for histomorphometric studies. The result of the study showed that all irradiated animals suffered weight loss by the 14th day post-irradiation (p<0.05) irrespective of the additional treatment with dexamethasone and this was statistically significant. Histomorphometry showed that the maximum width of the glomerular capsule was significantly greater in the radiation groups than in the control at p<0.05. The maximal glomerular diameter was significantly greater in irradiated animals compared with the control animals at p<0.05. The outcome of this study showed that the intraperitoneal administration of dexamethasone at 1mg/kg body weight/day for 2 days prior to treatment with irradiation did not prevent weight loss nor ameliorate the swelling of the nephrons resulting from the effect of radiation injury to the Wistar rat.

Fue estudiado el efecto anti-inflamatorio de la dexametasona en riñones irradiados de 18 ratas Wistar adultas (Rattus norvegicus). Luego de la aclimatización, aleatoriamente se dividieron en 3 grupos de 6 animales por grupo. El grupo control recibió una solución salina normal, sin recibir drogas ni radiación. El segundo grupo recibió solución salina normal y radiación. El tercer grupo recibió tratamiento previo con dexametasona con 1 mg / kg de peso corporal / día, durante 2 días, seguido de radiación. Los animales fueron expuestos a radiación con una fracción independiente de 2.5 Gy de rayos gamma por una fuente de Cobalto-60, usando una máquina de teleterapia AECL Theatron 780-C. Después de la exposición a las diferentes intervenciones, los animales fueron sacrificados el día 14 post-irradiación y los riñones de cada uno de los animales fueron disecados. Los tejidos renales fueron sometidos a procesamiento histológico, y luego se estudiaron utilizando un objetivo ocular milimetrado calibrado a 2mm para el estudio histomorfométrico. Se demostró que todos los animales irradiados sufrieron pérdida de peso 14 días después de ésta (p <0.05), independientemente de los tratamientos adicionales con dexametasona , siendo estadísticamente significativo. La histomorfometría mostró que el ancho máximo de la cápsula glomerular fue significativamente mayor en los grupos irradiados que en el control en p <0.05. El diámetro máximo del glomérulo fue significativamente mayor en los animales irradiados en comparación con los animales control p <0.05. Los resultados de este estudio mostraron que la administración intraperitoneal, de 1 mg / kg de peso corporal / día durante 2 días, de dexametasona antes de comenzar el tratamiento con irradiación, no impide la pérdida de peso ni permite aliviar el edema de los nefrones, injuria producto de la radiación a las Ratas Wistar.

HLA-DRB1 genotyping in children with nephrotic syndrome of non-IgA mesangial proliferative giomerulonephritis / 中华微生物学和免疫学杂志

Objective To investigate the association of HLA-DRB1 alleles in Han population of Shanxi childrcn with nephrotic syndrome of non-IgA mesangial proliferative glomerulonephritis (MsPGN). Methods HLA-DRB1 was performed by polymerase chain reaction-sequence specific primers technique, and twenty patients with nephrotic syndrome of non-IgA MsPGN were detected. Results Analysis of the fre- quencies of specific at the HLA-DRB1 loci revealed significantly higher frequencies of HLA-DRB1 * 11 al- leles among the nephrotic syndrome patients of non-IgA MsPGN comparing with controls (22. 50% vs 8.33%, x2= 9. 544, P = 0.002, CI = 1. 674-9.995, RR = 4.09). Nine patients with HLA-DRB1 * 11 all accompanied hematuria, hypertension or short renal insufficiency. Conclusion The results suggested that HLA-DRB1 * 11 alleles contribute to genetic susceptibility to nephritic syndrome of non-IgA MsPGN. The pa- tients with HLA-DRB1 *11 easy accompanied hematuria, hypertension or short renal insufficiency.

A Case of IgA Nephropathy Associated with Acute Myeloid Leukemia / 대한신장학회잡지

The incidence of glomerulonephritis associated with malignancy is not common. Membranous glomerulonephritis associated with carcinomas and minimal change nephrotic syndrome with Hodgkin's disease has been occasionally reported. The pathogenesis of glomerular injury associated with malignancy is not well known. The IgA nephropathy associated with malignancy, though rare, has been reported. IgA nephropathy associated with acute myeloid leukemia, however, is yet to be reported. We hereby report a case of IgA nephropathy associated with acute myeloid leukemia (AML M2).

A Case of IgA Nephropathy Associated with Acute Myeloid Leukemia / 대한신장학회잡지

The incidence of glomerulonephritis associated with malignancy is not common. Membranous glomerulonephritis associated with carcinomas and minimal change nephrotic syndrome with Hodgkin's disease has been occasionally reported. The pathogenesis of glomerular injury associated with malignancy is not well known. The IgA nephropathy associated with malignancy, though rare, has been reported. IgA nephropathy associated with acute myeloid leukemia, however, is yet to be reported. We hereby report a case of IgA nephropathy associated with acute myeloid leukemia (AML M2).

Altered Expression of Nephrin, Glomerular Epithelial Cell Protein-1 (GLEPP1) and WT-1 in Glomerular Disease

BACKGROUND: Glomerular epithelial cell protein-1 (GLEPP1) and WT-1 expressed in mature visceral glomerular epithelial cell (VGEC) is required for maintenance of the mature status of VGEC. Nephrin protein is located at the filtration slit and regarded as a molecular component of the slit diaphragm. Alterations of these proteins in proteinuric diseases are not clearly defined. METHODS: We investigated the expression of GLEPP1, WT-1 and nephrin in 28 renal biopsies diagnosed with minimal change nephropathy (n=10), focal glomerulosclerosis (n=10) and membranous nephritis (n=8) by immunohistochemical staining. Normal control biopsies were obtained from six nephrectomy specimens. RESULTS: The patients consisted of 15 males and 13 females. The mean age was 40.7 years. Nephrotic range proteinuria (> or =3.5 g/day) was noted in 15 (54%) patients. GLEPP1 and nephrin expression were significantly decreased in patients as compared with those of the controls (p<0.05). The mean number of WT-1 expressing cells per glomerulus was also significantly decreased in patients as compared with those of the controls (p<0.05). However, there was no significant difference in the number of WT-1 expressing cells among the disease groups. CONCLUSIONS: These results suggest that the loss of biological markers of mature VGEC may play an important role in the pathogenesis of proteinuria.

Implication of Angiotensin Converting Enzyme Gene Polymorphism on Renal Progression of Primary Nephrotic Syndrome in Children / 대한신장학회잡지

Human angiotensin converting enzymcC4CE) gene displays an insertion/deletion polymorphism in 16 intron, and three genotypes are determined by presence or absence of a 287-bp fragment of DNA; II, ID and DD genotype. DD genotype has been suggested as a risk factor of various cardiovascular diseases and chronic nephropathies such as IgA nephropathy and diabetic nephropathy. This study was designed to investigate if the ACE polymor-phism is related to the clinical and pathologic findings of minimal change nephrotic syndrome(MCNS) and focal segmental glomerulosclerosis(FSGS) in children. Ninety children with primary nephrotic syndrome(MCNS and steroid responsive nephrotic syndrome : 68 cases, FSGS; 22 cases) and 97 healthy normal controls were examined. The genotype for the polymorphism was determined by PCR method. The distribution of ACE genotypes in primary nephrotic syndrome(II 28.6%, ID 53.8%, DD 17.6%) was not different from that in controls(II 39.2%, ID 41.2%, DD 29.6%). The IJ genotype was more frequent in FSGS(II 64.7%, ID 23.5%, I)D 11.8%) than in MCNS and steroid responsive nephrotic syndrome(I 20.3%, ID 60.8%, DD 18.9%, p<0.03). The ACE genotypes were not associated either with frequency of relapse in MCNS or steroid responsive nephrotic syndrome or with presence of hypertension, responsiveness to steroid therapy and progression of renal dysfunction in FSGS. We concluded that deletion polymorphism of ACE gene is not associated with increased risk for renal progression in children with primary nephrotic syndrome.

Thirty Cases of IgA Nephropathy Treated by Differential Diagnosis of Syndromes in TCM / 中医杂志

Thirty caaes diagnosed as lGA nephroparthyby kidney biopay were treated bassed on differential diagnosis of syndromes the cases were divided into several stages via lesion in the lung -kidney (initial stage )lesion in the spleen-kidney (stable atage )and lesion in the liver -kidney (stable atage)and relapsing stage, and were treated by Chinese medicaments accordingly. The results revealed that 10 cases were totally mitigated; 13 cases, markedly alleviated; 4 cases, ameliorated, with only 3 cases ineffective. The total effecitve rate was 90%.Thirty cases diagnosed as IgA nephropathy by kidney biopsy were treated based on differential diagnosis of syndromes. The cases were divided into several stages, viz. lesion in the lung -kidney ( initial stage) , lesion in the spleen - kidney (stable stage) and lesion in the liver -kidney (advanced stage) and relaps-