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- The periglomerular fibrosis
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I often ignore the periglomerular fibrois when I sign out kidney biopsies. Here is one paper which emphasizes the importance of periglomerular fibrosis. Arch Pathol Lab Med. 2011 Jan;135(1):117-22. The relevance of periglomerular fibrosis in the evaluation of routine needle core renal biopsies. Jenkins J, Brodsky SV, Satoskar AA, Nadasdy G, Nadasdy T.
Abstract
Renal interstitial fibrosis and, to a lesser extent, sclerotic glomeruli correlate with poor renal function. However, not all nonfunctional glomeruli are sclerotic. Many or most glomeruli with periglomerular fibrosis, while retaining blood flow, probably do not filter; therefore, they may not contribute to renal function. Objective-To examine the relationship of periglomerular fibrosis and the sum of globally sclerotic glomeruli and glomeruli with periglomerular fibrosis (GSG+PF) with interstitial fibrosis and renal function. Design-Native kidney biopsies from 177 patients with chronic renal injury were assessed for interstitial fibrosis, glomerular sclerosis, and GSG+PF. Renal biopsies with active or acute lesions were not included. The percentage of globally sclerotic glomeruli and GSG+PF was correlated with the degree of interstitial fibrosis and serum creatinine levels. Results-The percentage of GSG+PF correlates better with the degree of interstitial fibrosis and renal function than does the percentage of globally sclerotic glomeruli alone. This appears particularly true in chronic renal diseases of patients without diabetes. The number of globally sclerotic glomeruli correlates better with interstitial fibrosis and renal function than does the sum of globally and segmentally sclerotic glomeruli. Conclusions-The percentage of GSG+PF in a renal biopsy specimen provides a better estimate of chronic renal injury than does the percentage of sclerotic glomeruli alone, probably because many or most glomeruli with periglomerular fibrosis are nonfunctional. Therefore, we recommend that the number of glomeruli with periglomerular fibrosis also be provided in the renal biopsy report.
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本帖最后由 于 2011-01-17 01:24:00 编辑
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引用 1 楼 QWM 在 2011-10-18 09:02:21 的发言:
Hello, Doctor Qu, I would like to ask you whether your renal biopsy report includes the number of glomeruli with periglomerular fibrosis when you sign out kidney biopsies now.
Yes, I include the number of glomeruli with periglomerular fibrosis in medical and transplant kidney biopsy report now.
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Hi, Dr. Qu, I have a question want to ask you. When the kidney needle biopsy tissue in electron microscopy fixative fixed for too long will cause the dissipation of the immune deposits? I have a case of Membranous Nephropathy diagnosed under light microscope(Immunofluorescence IgG+)，however, for the tissue in the glutaraldehyde fixative for too long，I can not find the immune deposit in the subepithelial under the electron microscope.
引用 3 楼 jessica2011 在 2011-11-01 09:54:59 的发言:
Hi, Dr. Qu, I have a question want to ask you. When the kidney needle biopsy tissue in electron microscopy fixative fixed for too long will cause the dissipation of the immune deposits? I have a case of Membranous Nephropathy diagnosed under light microscope(Immunofluorescence IgG+)，however, for the tissue in the glutaraldehyde fixative for too long，I can not find the immune deposit in the subepithelial under the electron microscope.
To my knowledge, any tissue sample may stay in glutaraldehyde for very long time (more than a year) and will not affect the ultrastructure including electron dense deposits. For your particular question, immunofluorescence microscopy shows a membranous pattern deposits. But EM could not demonstrate deposits. There are a couple of possibilities: 1) EM sample is not the sample of this patient; 2) the deposits may be extremely small and scattered; 3) did you see spikes in silver stain? does patient have proteinuria? If not, you may need to re-interprete your immunofluorescence stains.
