Dlhodobá dialyzačná liečba chronickej obličkovej nedostatočnosti sprevádzaná získanou cystickou chorobou obličiek a súčasnými prednádorovými zmenami a mnohopočetnými nádormi ľavej obličky

English version

Autoři: A. Böör; I. Jurkovič; Z. Havierová; P. Kočan
Působiště autorů: Department of Pathology, Faculty of Medicine, P. J. Šafárik University in Košice, Slovak Republic
Vyšlo v časopise: Čes.-slov. Patol., 46, 2010, No. 4, p. 105-110
Kategorie: Původní práce

Souhrn

Cieľ práce:
opis a imunohistochemická analýza prednádorových zmien a nádora obličky u pacienta s chronickou obličkovou nedostatočnosťou liečenou dlhodobou hemodialýzou.

Metódy:
Nefrektomický bioptický materiál (ľavá oblička), bol vyšetrený mikroskopicky a polaroskopicky. Ďalej boli na analýzu použité tieto protilátky: CK1/CK3, CK5/6, CK8, CK20, EMA, „Renal cells“, CD10, Ki-67, PCNA, p53 a E-cadherin.

Hlavné nálezy:
Operačný preparát pochádzal z pacienta, liečeného pre renálnu insuficienciu 11 rokov hemodialýzou pre diabetickú nefropátiu a chronickú tubulointersticiálnu nefritídu. Indikáciou pre urgentnú nefrektómiu bola bolesť a masívne intrarenálne krvácanie. Spolu s nálezom vyššie uvedených obličkových ochorení zistili sme rozvinutý nález získanej cystózy vznikajúcej počas dlhodobej dialýzy, viaceré malé papilárne adenómy a multifokálne karcinómy z buniek obličky vykazujúce konvenčný, ďalej papilárny a sarkomatoidný charakter. Prítomné boli tiež známky ťažkej vaskulárnej nefrosklerózy a uremickej oxalózy. Horný pól orgánu bol masívne prekrvácaný.

Závery:
Nami popísaný nález obsahuje súčasnú prítomnosť mikroskopických zmien vysvetľujúcich stav chronickej obličkovej nedostatočnosti s prítomnou uremickou oxalózou, kombinovaných so získanou cystózou vznikajúcou v dôsledku dlhodobej hemodialýzy. V takto zmenenom orgáne sa nachádzali dysplastické mikrotubulárne a intracystické zmeny, smerujúce ku vzniku viacerých papilárnych adenómov a multifokálnych karcinómov z buniek obličky, vyznačujúcich sa rôznorodou diferenciáciou.

Kľúčové slová:
chronická renálna insuficiencia – získaná cystická choroba obliček – prekarcenózne zmeny – nádory obličky

Zdroje

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