Contribution of irreversible morphological changes of different renal structures to development of anemia in immune glomerulopathies


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Aim. To find out correlations between severity of sclerotic affection of the glomeruli, tubules, interstitium, vessels and development of anemia in patients with glomerulopathy. Material and methods. Assay of global and segmentary sclerosis, semiquantitative morphometry of severity of atrophic tubular changes, diffuse interstitial fibrosis, vascular changes (arteriolohyalinosis, elastofibrosis and perivascular sclerosis) were made in parallel with analysis of clinical laboratory data in 276 cases of chronic primary glomerulopathy with morphologically verified diagnosis by vital renal biopsy. Results. Hemoglobin concentration and advance of anemia correlate negatively with severity of diffuse interstitial fibrosis and atrophic tubular alterations. However, no correlation was found between onset of anemia, severity of global and segmental glomerular sclerosis, the presence of vascular changes in the form of arteriolar hyalynosis, elastofibrosis of small arteries and perivascular sclerosis. Conclusion. The findings suggest that development of anemia in patients with primary glomerulopathy may be the result of structural-functional disturbances in tubular epithelium and renal stroma.

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Значение необратимых морфологических изменений различных почечных структур в развитии анемии при иммунных гломерулопатиях. - Цель исследования. Установить связь между выраженностью склеротических изменений клубочков, канальцев, интерстиция и сосудов и развитием анемии у больных с различными вариантами гломерулопатий. Материалы и методы. В исследование были включены 276 случаев хронических первичных гломерулопатий с морфологическим подтверждением диагноза посредством прижизненной биопсии почки. Были проведены количественная оценка глобального и сегментарного склероза, полуколичественная морфометрия выраженности атрофических изменений канальцев, диффузного интерстициального фиброза, сосудистых изменений (артериологиалиноза, эластофиброза и периваскулярного склероза) параллельно с анализом клинико-лабораторных данных. Результаты. Установлено, что концентрация гемоглобина и распространенность анемии обратно связаны с выраженностью диффузного интерстициального фиброза и атрофических изменений канальцев. Вместе с тем не обнаружено зависимости между развитием анемии и выраженностью глобального и сегментарного склероза клубочков, наличием сосудистых изменений в виде гиалиноза артериол, эластофиброза мелких артерий и периваскулярного склероза. Заключение. Полученные данные позволяют считать развитие анемии у больных первичными гломерулопатиями закономерным следствием структурно-функциональных нарушений в эпителии канальцев и строме почки.
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