Atheromatous emboli in renal biopsies. An ultrastructural study
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Abstract:
In a series of 755 renal biopsies atheromatous emboli were found in biopsies of 8 men from 49 to 72 years of age. Unexplained recent deterioration of renal function was present in each. This previously unreported incidence of 8/755 biopsies is ascribed to the selection for biopsy of patients with unexplained decrease in renal function. Hypertension was a major feature in 6, hyperlipidemia in 2, a leaking aortic aneurysm in 1, carcinoma of the pancreas in 1, and chronic glomerulonephritis in 1 patient. Toluidine-blue-stained epoxy sections proved to be more effective in recognizing small emboli than paraffin sections. Ultrastructural observation concerned a) early lesions (eg, fresh emboli with endothelial distortion or injury), b) intermediate lesions (eg, histiocytic or giant cell reaction and intimal proliferation), and c) later lesions (eg, extraluminalization of the crystals eventually resulting in inert location in intimal stroma). Osmiophilic deposits on the crystal surfaces were myelin-form in structure and were felt to result from lysosomal action.
Insights
Atheromatous emboli were found in 8 men undergoing renal biopsies for unexplained kidney function decline. This study highlights their presence and pathological changes in kidney tissue.
Area of Science:
- Nephrology
- Pathology
- Cardiovascular Medicine
Background:
- Atheromatous emboli are a potential cause of renal dysfunction.
- Their incidence in renal biopsies for unexplained renal function deterioration is not well-documented.
Purpose of the Study:
- To report the incidence of atheromatous emboli in renal biopsies.
- To describe the pathological features and clinical associations of atheromatous emboli in renal biopsies.
Main Methods:
- Analysis of 755 renal biopsies.
- Histological examination using toluidine-blue-stained epoxy sections and paraffin sections.
- Ultrastructural observation of atheromatous emboli and associated renal lesions.
Main Results:
- Atheromatous emboli were identified in 8 out of 755 renal biopsies (1.06%).
- Patients presented with unexplained recent deterioration of renal function.
- Associated conditions included hypertension, hyperlipidemia, aortic aneurysm, pancreatic carcinoma, and chronic glomerulonephritis.
- Toluidine-blue-stained epoxy sections were superior to paraffin sections for detecting small emboli.
- Ultrastructural analysis revealed early, intermediate, and late stages of atheromatous embolism, including myelin-form osmiophilic deposits.
Conclusions:
- Atheromatous embolism should be considered in patients with unexplained renal function decline.
- Specific histological techniques enhance the detection of atheromatous emboli.
- The pathological progression of atheromatous embolism in renal tissue can be characterized by distinct ultrastructural changes.