腎生検で診断し得たコレステロール塞栓症の２例:腎組織に出現した炎症細胞についての検討

概要

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Two cases of cholesterol embolism are presented and inflammatory cells in the kidney were studied immunohistochemically. Both cases had clinically acute renal failure after an angiography, and were diagnosed with cholesterol embolism by renal biopsies which revealed characteristic needle-shaped cholesterol crystals in the lumen of arteries and arterioles and in the glomeruli.Histopathologically, inflammatory cells infiltration was focal around cholesterol crystal, along the arteries, and in the renal interstitium with tubular atrophy.Immunohistochemically, macrophages, T and B lymphocytes, mast cells and eosinophils were increased in the interstitium. Macrophages and T cells were closely associated with cholesterol crystals in the lumen of arteries. Other inflammatory cells were not associated with cholesterol crystals. Mast cells as well as macrophages and T lymphocytes had infiltrated into tubules. Electron microscopically, mast cells were found to have infiltrated into distal tubules with degranulation of specific granules. These results suggest that inflammatory cells play different roles in the interstitium of the patient with cholesterol embolism :macrophages and T cells were first recruited to the area around cholesterol crystals, followed by an increase in mast cells and other inflammatory cells in the interstitium where tubulointerstitial lesions were formed.
信州医学会の論文