Abstract：
BACKGROUND: Fibrosis is a common final pathway leading to end-stage renal failure. As the renal medulla and cortex contain different nephron segments, we analyzed the factors associated with the progression of renal medullary and cortical fibrosis.
METHODS: A total of 120 patients who underwent renal biopsy at Kawashima Hospital between May 2019 and October 2022 were enrolled in this retrospective study. Renal medullary and cortical fibrosis and stiffness were evaluated using Masson\'s trichrome staining and shear wave elastography, respectively. Maximum urine osmolality in the Fishberg concentration test was also examined.
RESULTS: Medullary fibrosis was positively correlated with cortical fibrosis (p < 0.0001) and log-converted urinary β2-microglobulin (MG) (log urinary β2-MG) (p = 0.022) and negatively correlated with estimated glomerular filtration rate (eGFR) (p = 0.0002). Cortical fibrosis also correlated with log urinary β2-MG, eGFR, and maximum urine osmolality. Multivariate analysis revealed that cortical fibrosis levels (odds ratio [OR]: 1.063) and medullary stiffness (OR: 1.089) were significantly associated with medullar fibrosis (≧45%). The severe fibrosis group with both medullary fibrosis (≧45%) and cortical fibrosis (≧25%) had lower eGFR and maximum urine osmolality values and higher urinary β2-MG levels than the other groups.
CONCLUSIONS: Patients with disorders involving both renal medullary and cortical fibrosis had decreased maximum urine osmolality but had no abnormalities in the urinary concentrating capacities with either condition. Renal medullary and cortical fibrosis were positively correlated with urinary β2-MG, but not with urinary N-acetyl-beta-D-glucosaminidase.
METHODS: A total of 120 patients who underwent renal biopsy at Kawashima Hospital between May 2019 and October 2022 were enrolled in this retrospective study. Renal medullary and cortical fibrosis and stiffness were evaluated using Masson\'s trichrome staining and shear wave elastography, respectively. Maximum urine osmolality in the Fishberg concentration test was also examined.
RESULTS: Medullary fibrosis was positively correlated with cortical fibrosis (p < 0.0001) and log-converted urinary β2-microglobulin (MG) (log urinary β2-MG) (p = 0.022) and negatively correlated with estimated glomerular filtration rate (eGFR) (p = 0.0002). Cortical fibrosis also correlated with log urinary β2-MG, eGFR, and maximum urine osmolality. Multivariate analysis revealed that cortical fibrosis levels (odds ratio [OR]: 1.063) and medullary stiffness (OR: 1.089) were significantly associated with medullar fibrosis (≧45%). The severe fibrosis group with both medullary fibrosis (≧45%) and cortical fibrosis (≧25%) had lower eGFR and maximum urine osmolality values and higher urinary β2-MG levels than the other groups.
CONCLUSIONS: Patients with disorders involving both renal medullary and cortical fibrosis had decreased maximum urine osmolality but had no abnormalities in the urinary concentrating capacities with either condition. Renal medullary and cortical fibrosis were positively correlated with urinary β2-MG, but not with urinary N-acetyl-beta-D-glucosaminidase.
摘要：
背景：纤维化是导致终末期肾衰竭的常见最终途径。由于肾髓质和皮质含有不同的肾单位段，我们分析了与肾髓质和皮质纤维化进展相关的因素。
方法：这项回顾性研究共纳入了2019年5月至2022年10月在川岛医院接受肾活检的120例患者。使用Masson三色染色和剪切波弹性成像评估肾髓质和皮质纤维化和硬度，分别。还检查了Fishberg浓度测试中的最大尿液渗透压。
结果：髓质纤维化与皮质纤维化（p<0.0001）和对数转化尿β2-微球蛋白（MG）（对数尿β2-MG）（p=0.022）呈正相关，与估算的肾小球滤过率（eGFR）呈负相关（p=0.0002）。皮质纤维化也与尿β2-MG对数相关，eGFR,和最大尿液渗透压。多变量分析表明，皮质纤维化水平（比值比[OR]：1.063）和髓质硬度（OR：1.089）与髓质纤维化显着相关（≥45％）。具有髓样纤维化(≥45%)和皮质纤维化(≥25%)的严重纤维化组比其他组有更低的eGFR和最大尿渗透压值和更高的尿β2-MG水平。
结论：患有肾髓质和皮质纤维化的疾病的患者最大尿渗透压降低，但在两种情况下的尿浓缩能力均无异常。肾髓质和皮质纤维化与尿β2-MG呈正相关,但不是尿N-乙酰-β-D-氨基葡萄糖苷酶。
方法：这项回顾性研究共纳入了2019年5月至2022年10月在川岛医院接受肾活检的120例患者。使用Masson三色染色和剪切波弹性成像评估肾髓质和皮质纤维化和硬度，分别。还检查了Fishberg浓度测试中的最大尿液渗透压。
结果：髓质纤维化与皮质纤维化（p<0.0001）和对数转化尿β2-微球蛋白（MG）（对数尿β2-MG）（p=0.022）呈正相关，与估算的肾小球滤过率（eGFR）呈负相关（p=0.0002）。皮质纤维化也与尿β2-MG对数相关，eGFR,和最大尿液渗透压。多变量分析表明，皮质纤维化水平（比值比[OR]：1.063）和髓质硬度（OR：1.089）与髓质纤维化显着相关（≥45％）。具有髓样纤维化(≥45%)和皮质纤维化(≥25%)的严重纤维化组比其他组有更低的eGFR和最大尿渗透压值和更高的尿β2-MG水平。
结论：患有肾髓质和皮质纤维化的疾病的患者最大尿渗透压降低，但在两种情况下的尿浓缩能力均无异常。肾髓质和皮质纤维化与尿β2-MG呈正相关,但不是尿N-乙酰-β-D-氨基葡萄糖苷酶。
