Renal histopathology of stone-forming patients with distal renal tubular acid

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Title：Renal histopathology of stone-forming patients with distal renal tubular acidosis
结石形成伴远端肾小管酸中毒患者的肾脏组织病理改变

Author： Evan AP, Lingeman J, Coe F, Shao Y, Miller N, Matlaga B, Phillips C, Sommer A, Worcester E

Resource：Kidney International (2007) 71, 795–801

Abstract：
To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients.
为了明确在结石形成伴远端肾小管酸中毒的患者中肾脏的组织改变，我们对五名患者实施了术中肾乳头和皮质活检。

The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked.
主要的异常是磷酸钙以磷灰石的形式沉积在内髓集合管和Bellini管，造成其堵塞；上皮细胞的损伤和脱落是明显的。

Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present.
堵塞的内髓集合管和Bellini管被间质性纤维化组织所包绕，但这种纤维化是普遍存在的，甚至当堵塞的情况不存在时也是组织病理学的一个主要特征。

In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis.
相比之下，常见的特发性草酸钙结石患者从不出现小管内晶体或间质性纤维化。

Patients with bru***e (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts.
磷酸氢钙结石患者和胱氨酸结石患者很少出现内髓集合管和Bellini管被磷灰石(或胱氨酸尿中的胱氨酸)堵塞的情况，间质性纤维化也局限于堵塞的小管周围区域。

Patients with dRTA often present a radiographic picture of nephrocalcinosis.
伴有远端肾小管酸中毒的患者通常在影像学上表现为肾钙质沉着。

Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function.
我们直接的外科观察表明这些可能是通过外科手术可以去除的结石，尤其是对于肾功能完好的患者。

In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.
总之，伴有远端肾小管酸中毒的结石患者与其他已研究过的结石患者相比，乳头的肾脏病变更加弥散，间质性纤维化的程度也是异乎寻常的。