为了对同种异体肾脏和天然肾脏疾病的患者进行最佳管理,识别与年龄相关的组织学特征很重要。这是因为大多数病理结果是非特异性的。最近已提出中央纤维区(CFA)与年龄相关。然而,CFA的成分以及是否在各种肾脏疾病中观察到CFA仍未确定。这项横断面研究是为了阐明组织学特征,流行病学,CFAs的临床病理特征。
2015年,从北陆地区的七个机构回顾性地收集了一百一十个连续的肾针活检标本,并在金泽大学医院进行了诊断。首先,使用正常组织染色分析CFA的成分,免疫染色,和电子显微镜。第二,根据获得的样本中是否存在CFA,将患者分为两组(CFA[+]或CFA[-])。比较两组患者的临床及组织学特点,使用单变量和多变量分析确定与CFA形成相关的因素。在CFA(+)组中对每个样本的CFA的数量进行计数。第三,通过免疫染色检查CFA中肌成纤维细胞的存在。
在101名患有各种肾脏疾病的患者中的56名(55.4%)中观察到CFA。CFA由原纤维胶原蛋白(胶原蛋白I和III)以及非原纤维胶原蛋白(胶原蛋白IV和VI)组成,由电子显微镜证实。临床上,与CFA(-)组相比,CFA(+)组年龄较大,高血压和高脂血症的患病率明显较高.组织学上,小叶间动脉弹性纤维化,小动脉透明症,CFA(+)组和膜性肾病明显高于CFA(-)组。多因素分析显示,年龄是CFA形成的唯一相关因素。最后,在26例中,58例(46.6%)含CFA的肾小球中有27例包括CFA中或附近的α-平滑肌肌动蛋白阳性细胞。
除了基质胶原之外,CFA还由纤维胶原组成。CFA的形成与年龄有关,并在各种肾脏疾病中观察到。
For the optimal management of patients with both allograft kidneys and native kidney diseases, the recognition of the histological features associated with older age is important. This is because most pathological findings are non-specific. Central fibrous areas (CFAs) have recently been proposed to be age-related. However, the components of CFAs and whether CFAs are observed in various kidney diseases remain undetermined. This cross-sectional
study was undertaken to clarify the histological features, epidemiology, and clinicopathological features of CFAs.
One hundred and one consecutive kidney needle biopsy specimens were retrospectively collected from seven facilities in the Hokuriku region and diagnosed at the Kanazawa University Hospital in 2015. First, the components of CFAs were analyzed using normal histostaining, immunostaining, and electron microscopy. Second, the patients were divided into two groups (CFA [+] or CFA [-]) according to the presence of CFA in the obtained samples. Clinical and histological features were compared between the two groups, and factors associated with CFA formation were determined using univariate and multivariate analyses. The number of CFAs per specimen was counted in the CFA (+) group. Third, the presence of myofibroblasts in CFA was examined by immunostaining.
CFAs were observed in 56 of 101 patients (55.4%) with various kidney diseases. CFAs consist of fibrillar collagens (collagen I and III) in addition to non-fibrillar collagens (collagen IV and VI), as confirmed by electron microscopy. Clinically, the CFA (+) group was older and had a significantly higher prevalence of hypertension and hyperlipidemia than the CFA (-) group. Histologically, elastofibrosis of the interlobular artery, arteriolar hyalinosis, and membranous nephropathy were significantly more evident in the CFA (+) group than in the CFA (-) group. Multivariate analysis revealed that older age was the sole factor associated with CFA formation. Finally, 27 of 58 (46.6%) CFA-containing glomeruli in 26 cases included alpha-smooth muscle actin-positive cells in or adjacent to the CFA.
CFAs consist of fibrous collagens in addition to matrix collagens. CFA formation is associated with older age and was observed in various kidney diseases.