Abstract: Almost 30 years after the detection of chronic interstitial nephritis in agricultural communities (CINAC) its etiology remains unknown. To help define this we examined 34 renal biopsies from Sri Lanka, El Salvador, India and France of patients with chronic kidney disease 2-3 and diagnosed with CINAC by light and electron microscopy. In addition to known histopathology, we identified a unique constellation of proximal tubular cell findings including large dysmorphic lysosomes with a light-medium electron-dense matrix containing dispersed dark electron-dense non-membrane bound “aggregates”. These aggregates associated with varying degrees of cellular/tubular atrophy, apparent cell fragment shedding and no-weak proximal tubular cell proliferative capacity. Identical lysosomal lesions, identifiable by electron microscopy, were observed in 9% of renal transplant implantation biopsies, but were more prevalent in six month (50%) and 12 month (67%) protocol biopsies and in indication biopsies (76%) of calcineurin inhibitor treated transplant patients. The phenotype was also found associated with nephrotoxic drugs (lomustine, clomiphene, lithium, cocaine) and in some patients with light chain tubulopathy, all conditions that can be directly or indirectly linked to calcineurin pathway inhibition or modulation. One hundred biopsies of normal kidneys, drug/toxin induced nephropathies, and overt proteinuric patients of different etiologies to some extent could demonstrate the light microscopic proximal tubular cell changes, but rarely the electron microscopic lysosomal features. Rats treated with the calcineurin inhibitor cyclosporine for four weeks developed similar proximal tubular cell lysosomal alterations, which were absent in a dehydration group. Overall, the finding of an identical proximal tubular cell (lysosomal) lesion in CINAC and calcineurin inhibitor nephrotoxicity in different geographic regions suggests a common paradigm where CINAC patients undergo a tubulotoxic mechanism similar to calcineurin inhibitor nephrotoxicity.

Abstract: Laser microprobe mass spectrometry is used to identify intrarenal microliths; they appear to consist of either oxalate, urate or phosphate. Crystalline and amorphous deposits in rat and human kidney are pin-pointed by the laser beam and their chemical composition determined by mass spectrometry. The method has the potential for wide application in the identification of single organic, inorganic or combination crystals in histological sections.

Abstract: By means of laser microprobe mass analysis (LAMMA) platinum was detected in the renal proximal tubular cells of a dog that had been intravenously adminstered the antitumor drug cisplatin (5 mg per kg body weight). No definite subcellular localization of the heavy metal was obtained. Sample prparation and analytical features are examined to increase spatial resolution of analysis while maintaining sufficient detection efficiency. The LAMMA method is destructive, but the amount and type of evaporated material can readily be determined when using LAMMA in combination with transmission electron microscopy. Instrumental optimization and standardization of mass signals is possible by using platinum-loaded, ion chelating resin beads embedded and sectioned with the tissue.

Abstract: Using laser microprobe mass analysis, we studied the ultrastructural localization of aluminum in liver and bone tissue of chronic-hemodialysis patients with proven aluminum-induced osteomalacia. In the liver, aluminum was observed to be almost exclusively associated with iron. Detectable aluminum and large amounts of iron were found in lysosomes of both hepatocytes and Kupffer cells. In bone, aluminum was localized at the osteoid/calcified-bone interface and also was associated with iron in some cases.