燃煤型砷污染所致肾脏损害的病理特征及意义

目的探讨慢性燃煤型砷污染对人体肾脏损害的病理学特征及意义。方法采用MDTECH肾脏活检针对14例慢性燃煤型砷中毒患者进行右肾下极穿刺，将所获肾组织进行病理学观察。结果燃煤型砷污染所导致的肾脏损害在光镜下表现为肾小球体积增大，毛细血管内皮细胞肿胀，间质水肿，系膜细胞增多，炎性细胞浸润，近曲小管肿胀、变性、脂肪样变。电镜下显示肾小球间隙扩大，内皮细胞肿胀，足突融合，足细胞内见较多脂肪滴及溶酶体并伴轻度肿胀、溶解改变；基底膜呈节段性增厚，伴系膜细胞插入和轻度肿胀。结论燃煤型砷中毒患者肾实质呈慢性弥漫性损害改变。微小病变型肾病是慢性燃煤型砷污染对肾脏损害的主要病理学特征，这种损害最终可能发展成局灶性节段性肾小球硬化，从而导致慢性肾功能衰竭。

The pathological features and significance of renal function impairment by coal-burning aresnism

Objective To explore the pathological features and significance of renal function impaired by coal-burning aresnism. Methods The lower limit of right kidney from 14 aresnism patients were biopsied by MD TECH renal biopsy needle, and the pathological examination of kidney was made in all renal issue obtained. Results The pathologic observation of the aresnism patients under the optical microscope showed renal glomerular enlargement, swelling of blood capillary endothelial cell, stroma edema, basal lamina cells proliferation, proximal convoluted tubule swelling and fatty degeneration. Electron microscope showed enlarged space among renal glomeruli, endothelial cell swelling, podocyte integration, many lipid particles and lysosomes swelling and solution in podocytes. Segmental hyperplasia with mesangial cells inserted and swelled in basilemma. Conclusions The impairment of kidney in coal-burning arsenic poisoning patients is chronic and diffuse. The nephropathy of minute lesion is the main pathological feature of the impairment caused by coal-burning aresnism, which may induce localized segmental glomerulosclerosis and finally lead to chronic renal failure.