Publication: Medial artery calcification of uremic patients: a
histological, histochemical and ultrastructural study
Authors
Ballanti, P. ; Silvestrini, G. ; Pisanò, S. ; De Paolis, P. ; Di Giulio, S. ; Mantella, D. ; Lappelli, M. ; Favarò, A. ; Bonucci, E. ; Coen, G.
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Publisher
Murcia: F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
Recent findings suggest that vascular
calcification (VC) is an active process similar to bone
mineralization, the vascular smooth muscle cells
(VSMCs) undergoing phenotypic differentiation into
osteoblastic cells and synthesizing calcificationregulating
proteins found in bone. This study has
investigated the VC process of uremic patients, with a
morphologic approach. Epigastric artery samples from
49 uremic, non-diabetic patients were taken during
kidney transplantation. Sections from paraffin-embedded
samples were stained with hematoxylin/eosin and von
Kossa. CD68 was immunohistochemically detected, and
sections from frozen samples were stained with Oil Red
O. Deeply calcified samples were stained with
Picrosirius Red, PAS, and Alcian blue. Specimens from
one patient with moderate and one with severe VC were
examined under the electron microscope. None of the
samples had atherosclerosis. Calcifications were found
in the media of 38 patients. In 23, dot-like calcifications
were irregularly scattered near the adventitia (light VC);
in 11, granular calcifications formed concentric rings
near the adventitia (moderate-advanced VC); in 4, zones
of consolidated calcifications were found (severe VC).
These zones were poor in collagen, glycoproteins and
proteoglycans. In cases with moderate or severe VC,
VSCMs showed necrotic changes. Matrix vesicles could
be recognized in the extracellular spaces. In cases with
severe VC, uncalcified or partially calcified
membranous bodies were found, together with
Liesegang rings. Patches of fibrin were also found.
These findings point to a mainly degenerative
mechanism of VC, which proceeds from the outer
portion of the media. An active mechanism, however,
cannot be excluded. A unifying hypothesis is suggested.
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