Khoroshinina L.P, D M S, Professor
Lawson Arman. H. D M S, , Professor
Khoroshinina L.P. Doctor of medical sciences, Professor of the Department of Faculty Therapy namedV.A.Waldman ‘St. Petersburg State Paediatric Medical University’, Ministry of Health of the Russian Federation.
Lawson Arman. H. , D M S, Professor.
Introduction. According to WHO experts, by the end of the twentieth century in all countries of the world 33 % of starving children were officially registered [De Onis M., 2000]. In scientific literature the problem of remote consequences of prolonged starvation of children and adolescents, including the state of renal tissue in people who survived prolonged periods of starvation in childhood is of interest. Material and methods Fragments of kidney tissue taken at autopsy from 18 patients (9 men and 9 women) who died in the St. Petersburg Hospital for War Veterans (SPb GVV) at the age of 63 to 77 years were studied. The main group consisted of 10 adult patients who survived the siege of Leningrad in their childhood, and the comparison group consisted of 8 patients who had escaped the living conditions in the besieged city in their childhood. Histological and morphometric studies were carried out in the same preparations in compliance with the standardisation norms recommended for histological studies. Histological features of renal tissue and morphometric parameters of the renal tubular apparatus at the stage of preclinical manifestations were studied. Patients with renal diseases, diabetes mellitus, obesity, arterial hypertension were excluded from the study.
Morphometric analysis was carried out using a research complex consisting of an Axiolab microscope, a colour video camera and a video card for image input into a computer. Computer morphometry was performed in the image analysis system ‘Video-Test’ designed for morphological study of histological preparations. 525 measurements (283 in the main group and 242 in the comparison group) were carried out using this method.
Statistical processing of the obtained data was carried out using the STATISTICA for Windows software system. The criterion of statistical reliability of the obtained conclusions was considered to be p<0,05 and lower for absolute values and t > 2 for relative values (t – criterion of difference of relative values, N.I. Vishnyakov, 2000).
Obtained results At carrying out light microscopy significant changes of the tubular apparatus of kidney tissue in people of the main group were noted: practically in all preparations there was a predominance of anaemia of the tubules; in single cases – full blood clotting of the tubular loops, which was distinguished by swelling of the basal membranes, noticeable at the usual stains under study, and unfolding at SHIC reaction; in some cases swollen endothelial cells were detected, increased cellularity due to proliferation of mesengial cells was noted, in some cases fusions between loops and sclerosis of separate tubules were detected. In the preparations of the comparison group full blood clotting of capillary loops was more often observed.
In addition to damage to the tubular apparatus of renal tissue in people of the main group, damage to tubules and interstitial tissue was observed: in tubules – vacuolated and balloon dystrophy, the severity of which was determined by mechanisms of thanatogenesis development; in stroma, in almost all cases – edema, especially pronounced in the cerebral layer, sclerosis and small lymphoplasmocytic infiltrates located around sclerosed tubules. In all cases there was a decrease in the volume of renal parenchyma, which was caused by sclerosis and hyalinosis (sclerohyalinosis) of approximately 2/3 of the tubules. In vessels there was a pronounced hyperelastosis and elastofibrosis of small arteries and hyalinosis of arterioles.
With the degree of reliability p<0,001 in the main group of people the smaller area of sclerosed tubules was determined (average values were 7153,9 μm 296,5 μm against 9051 μm 413,0 μm in the comparison group); smaller area of unsclerosed tubules (average values were 19969,5 μm 894,5 μm against 25678,8 μm 925,0 μm in the comparison group); smaller capillary network area of the tubules (mean values were 14808.0 μm 766.8 μm vs. 16873.3 μm 600.1 μm in the comparison group); overall smaller number of tubules (mean values were 112.8 0.5 vs. 115.4 0.3 in the comparison group) and higher number of sclerosed tubules (mean values were 15.3% 0.6% vs. 9.5% 0.1%). The number of sclerosed tubules in elderly people in the main group and in the comparison group did not exceed the age norms (15.3% and 9.5%, respectively), but the ratio of sclerosed to unsclerosed tubules was 1: 5.5 in the main group versus 1: 10.9 in the comparison group, indicating a higher frequency of sclerosed tubules in the main group.
Conclusions. : With a high degree of reliability in the group of people who survived the blockade of Leningrad in childhood there was determined a smaller area of sclerosed tubules, a smaller area of unsclerosed tubules, a smaller area of capillary network of tubules, a total smaller number of tubules, a larger number of sclerosed tubules, the ratio of the number of sclerosed and the number of unsclerosed tubules indicated a more frequent detection of sclerosed tubules and an earlier onset of sclerotic processes in the glomerular apparatus. Compared to the comparison group, the glomerular apparatus of the kidneys of adults in the main group, i.e. those who had experienced long periods of starvation in childhood in besieged Leningrad, showed pronounced processes of sclerosis, hyalinosis and lesions of the renal cortical layer.
List of literature:
1. Vishnyakov N.I. Basic methods of statistical research / N.I. Vishnyakov, V.A. Minyaev, L.A. Alekseeva // Methodical guidelines for students, residents and postgraduates. Ed. 2. SPb. : Издво NIIH SPb GU, 2000. 84 с.
2. De Onis M., Frongillo E.A., Blossner M. Is malnutrition declining? An analysis of changer in levels of child malnutrition since 1980 // Bull. of the World Health Or-ganisation.- Geneva, 2000.- Vol. 78., № 10.- P. 1222 – 1233.
