American Journal Of Biomedical Science & Pharmaceutical Innovation
31
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VOLUME
Vol.05 Issue06 2025
PAGE NO.
31-37
10.37547/ajbspi/Volume05Issue06-08
Characteristics of Morphometric Indicators of The
Kidneys in Gestancial Pyelonephritis According to
Pregnancy Parity
Tojiboev Timur
Andijan State Medical Institute, assistant, Uzbekistan
Khonkeldieva Hurmatoy
Associate Professor, Doctor of Medical Sciences, Andijan State Medical Institute, Uzbekistan
Ahmedova Muslima
Andijan State Medical Institute, Assistant, Uzbekistan
Received:
30 April 2025;
Accepted:
28 May 2025;
Published:
30 June 2025
Abstract:
Basically, the morphometric parameters of the cells and fibrous structures of the kidney in the
morphofunctionally actively stained areas were taken as the basis for expressing the trajectory of the values
measured during the morphometry process within a certain range by numbers. The specific features of the
morphometric parameters of the parenchymal and mesenchymal structures of the kidneys of 40 women who died
from gestational pyelonephritis, who underwent autopsy at the Republican pathologoanatomical center of
Uzbekistan, were studied using the Hamamatsu (QuPath-0.4.0, NanoZoomer Digital Pathology Image)
morphometric software. To determine the morphometric parameters, the location, size, area occupied, size of
cells, width of blood vessels, diameter, perimeter, volume of lumens in a given volume and other indicators were
obtained. In the study, the superiority of all morphofunctional parameters over the control group was up to 1.35
times in the I-pregnancy, up to 1.2 times in the II-pregnancy, which was explained by the weakness of
morphological adaptation mechanisms, a decrease in the age-related reactivity of vascular components.
Keywords:
Borphometry, kidney, gestational pyelonephritis, pregnancy.
Introduction:
According to the WHO (2022), pregnant
women make up an average of 11.7% of the world's
population. During the second and third trimesters of
pregnancy, the development of morphofunctional
obstructions in the urinary system can occur, leading to
compression of the ureters coming from the kidneys.
This causes urinary stasis and, with the addition of
infectious agents, results in the development of
gestational pyelonephritis [1, 2, 6].
The incidence rate of gestational pyelonephritis
corresponds to the number of pregnancies and births
and is observed in approximately 2
–
4% of all pregnant
women in the United States and European countries,
around 2
–
3% in Japan, South Korea, and India, and on
average 2
–
10% in CIS countries and the Russian
Federation. In the Republic of Uzbekistan, this indicator
averages 10
–
18%. The development of gestational
pyelonephritis during childbirth and the postpartum
period
accounts
for
approximately
6
–
25%,
underscoring the urgency of the problem.
The mortality rate due to kidney complications arising
during pregnancy and the postpartum period is on
average 1
–
3% per 1000 pregnant women [3, 4, 5].
Research aim and objectives
To study the changes in renal morphometric
parameters in gestational pyelonephritis depending on
pregnancy parity.
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
METHODS
The study was conducted at the Republican Center of
Pathological Anatomy between 2020 and 2023 and
involved 40 women who died during pregnancy due to
renal pathologies. The specific morphometric
characteristics of the renal parenchyma and
mesenchymal structures in cases of gestational
pyelonephritis were analyzed using the Hamamatsu
(QuPath-0.4.0, NanoZoomer Digital Pathology Image)
morphometric software.
RESULTS
For morphometric examination, kidney tissue samples
were obtained from the autopsies of patients who
suddenly died of myocardial infarction (control group,
n=17). As the experimental group, kidney tissue
samples were taken from autopsies of women of
various reproductive ages who died during pregnancy
due to acute renal diseases. The prepared kidney tissue
materials were scanned using the NanoZoomer, and
microimages were obtained.
Morphometric parameters were determined based on
cellular localization, volume, occupied area, size, width,
diameter, perimeter, lumen volume of blood vessels,
and other relevant indicators within a defined volume.
Specifically,
morphometric
analysis
identified
dystrophic changes in the functional active areas of the
renal parenchymal components, while inflammatory
changes were observed in the mesenchymal parts, such
as the glomeruli and tubules, which serve as key
indicators of pathological alterations.
Our study revealed distinctive features of the examined
tissue, including the complete integrity of all
glomerular blood vessels, a 17
–
28% increase in
glomerular weight compared to the control group,
focal detachment in the epithelium of proximal and
distal tubules, presence of coarse proteinaceous
inclusions in the cytoplasm, massive multifocal
desquamation in the epithelium, and nuclei exhibiting
karyopyknosis, karyorrhexis, and karyolysis due to
necrobiosis. Additionally, thickening of the basal
membrane of proximal tubules, accumulation of coarse
homogeneous proteinaceous substrate in the lumen of
distal tubules, massive congestion of peritubular
capillaries, diapadesis hemorrhages, and a significant
decrease in reabsorption capacity of proximal tubules
were observed.
Morphometrically, the changes associated with
gestational pyelonephritis were studied according to
the number of pregnancies.
Table 3.1.
Morphometric Parameters (number and micrometers) of Renal Injury Areas in
Gestational Pyelonephritis
Studied Parameters
Control Group I Trimester II Trimester
III
Trimester
R ≤ 0.01
Average diameter of renal
glomeruli
166.8±1.1
209.3±1.1 191.1±1.01 173.2±1.1
0.01
Glomerular perimeter
256.7±1.03
343±1.05
314.5±1.1 293.1±1.21
0.01
Area occupied by the
glomerular tuft (15000
µm²)
10365±5.61 12281±3.25 10995±8.3 10725±2.9
2
0.01
Shumlyansky–Bowman
space
18.31±1.01
15.21±1.01 17.42±0.97 18.21±1.01
Proximal
121.12±5.01
162.11±8.16 152.5±7.13 135.31±5.21
0.01
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tubule
diameter
Proximal
tubule lumen
diameter
Proximal
tubule
perimeter
Proximal
tubule area
(µm²)
43.01±0.01
36.2±1.01
37.1±1.01
39.2±1.01
0.01
243.12±1.65
284.15±1.16 265.31±1.32 251.42±1.2
0.01
716.48±312.6
5
774.1±1.12
745.1±1.76 725.1±1.1
0.01
Distal tubule
diameter
61.12±1.4
84.36±12.5
78.14±1.6
68.11±1.3
0.01
Collecting
duct lumen
diameter
31.16±6.59
42.18±6.25
39.7±1.4
34.01±1.06
0.01
Collecting
duct
perimeter
121.24±2.8
169.72±25.1 156.28±3.2 136.21±2.6
0.01
Collecting
duct area
(µm²)
1299.97±22.8
4
1559.96±23.4 1374.13±11.
15
1274.29±12.
52
0.01
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
Figure 1. In the image, centrally located dilated tubules appear irregularly oval
in shape and have undergone compressive deformation. Scanned using NanoZoomer.
Staining: H&E. Size: 20×10.
The average diameter of the renal glomeruli in the
control group was 166.8±1.1 µm. In comparison, this
parameter increased to 209.3±1.1 µm in the kidneys of
the first group of pregnant women with gestational
pyelonephritis during the first trimester, showing a
1.25-fold increase. These changes correspond to the
morphological signs described above, particularly the
vascular response within the glomerular capillary
network. The observed increase in filtration, marked
vasodilation, and enlargement of the glomeruli confirm
that these alterations are most pronounced in
gestational pyelonephritis occurring during the first
trimester.
In the second trimester, this indicator measured
191.1±1.01 µm. From an age-related perspective, this
is explained by a reduction in vascular elasticity, and
compared to the first-trimester group, vessels became
more fragile and thickened. As a result, the extent of
vasodilation was less pronounced. Nevertheless, this
parameter was still 1.15 times higher than that of the
control group, confirming its significance.
Figure 2. Graphical representation of the average perimeter of the
Shumlyansky–Bowman’s space of the renal glomerulus. Scanned using NanoZoomer.
Staining: H&E. Size: 20×10.
In the third trimester, the same parameter measured
173.2±1.1 µm. This value can be explained by age-
related changes, such as a marked reduction in vascular
elasticity, increased fragility of blood vessels compared
to groups I and II, and a decrease in elastic fibers within
the vessel walls. Additionally, reduced reabsorption
capacity in the renal tubules contributes to this finding.
The parameter was 1.03 times higher than that of the
control group, confirming its significance.
As for the glomerular perimeter, it was 256.7±1.03 µm
in the control group, while in the first trimester group,
it increased to 343±1.05 µm. This represents a 1.34-fold
increase, indicating significant vascular congestion
within the glomeruli and intensified filtration
processes, which in turn led to the expansion of
Bowman’s space, thus supporting the observed
morphological findings.
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
Figure 3. The renal glomerulus with illustrated epimetric and perimetric
measurements of the Shumlyansky–Bowman’s space, showing one-quarter of the
segmental diagonal diameter. Scanned using NanoZoomer. Staining: H&E. Size:
20×10.
In the second group (i.e., during the second trimester
of pregnancy), the perimeter of the renal glomeruli was
314.5±1.1 µm, showing a 1.22-fold enlargement. This
enlargement is explained by damage to the glomeruli
during chemotherapeutic treatment for gestational
pyelonephritis and by an increase in filtration
parameters.
In the third group (i.e., third trimester of pregnancy),
the glomerular perimeter measured 293.1±1.21 µm,
which is 1.14 times greater than in the control group.
This finding indicates a reduced adaptive response in
this stage of pregnancy.
The next morphometric indicator is the average area
occupied by the glomerular tuft (15000 µm²). In the
control group, this area was 10365±5.61 µm², whereas
in the first trimester, it increased to 12281±3.25 µm²,
confirming the results observed in the other
morphometric measurements. In terms of the
proportion of the glomerulus occupied by the capillary
tuft, 69.1% of the area was occupied in the control
group, compared to 82% in the first group. This
indicates pronounced vascular dilation and elevated
filtration capacity, as well as ongoing vascular damage
occurring in parallel. These findings collectively support
the notion that renal insufficiency may develop
following any course of chemotherapeutic treatment
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Figure 4.
Morphogram showing the perimeter, external diameter, and internal
(luminal) diameter of the proximal and distal renal tubules. Scanned using
NanoZoomer. Staining: H&E. Size: 20×10.
In the second group (i.e., second trimester of
pregnancy), the area occupied by the glomerular tuft
was 10,995±8.3 µm², comprising 73.3% of the total
glomerular area (15,000 µm²). Compared to the control
group, this represents a 4.2% increase, although
statistically of low significance.
In the third group (third trimester), the tuft area
measured 10,725±2.92 µm², accounting for 71.5% of
the total, which is very close to the control group and
statistically not significant, indicating that vascular
reactivity in the glomeruli during this period does not
differ substantially from the baseline.
The next stage of examination focused on the
Shumlyansky
–Bowman’s space, which is critical for
evaluating the morphofunctional characteristics of the
glomeruli. In the control group, the average width of
this space was 18.31±1.01 µm, while in the first
trimester group, it decreased to 15.21±1.01 µm,
indicating a narrowing of Bowman’s space. This is
interpreted as a result of the marked enlargement of
the capillary tuft and vascular hyperemia, reducing the
available space. This reflects a 1.2-fold decrease.
In the second trimester, the Bowman’s space measured
17.42±0.97 µm, showing a 10.5% reduction compared
to the control group, which was considered statistically
less significant.
In the third trimester, the measurement was
18.21±1.01 µm, with no meaningful difference from the
control group. This suggests that the structure and
function of the glomerular tuft and Bowman’s space
remained largely intact.
Subsequent
morphometric
analysis
involved
measurements of renal tubules in various projections,
comparing them to the control group.
For the proximal tubules, the average diameter in the
control group was 121.12±5.01 µm, while in the first
trimester, it expanded to 162.11±8.16 µm, showing a
1.2-fold increase. This can be attributed to increased
filtration activity, enhanced reabsorption, and the
development of dystrophic changes in tubular
epithelium, leading to cellular swelling and tubular
dilation.
In the second trimester, the proximal tubule diameter
reached 152.5±7.13 µm, 1.15 times larger than the
control group. This reflects ongoing epithelial damage,
with histological evidence (at 200× magnification) of
dystrophic changes, including hyaline droplet
degeneration and hydropic degeneration. Notable
findings included epithelial detachment, cellular
desquamation, and karyolysis-like foci.
In the third trimester, the proximal tubule diameter
was 135.31±5.21 µm, 1.12 times larger than in the
control group, and was considered statistically
significant. This enlargement is attributed to various
degrees of epithelial swelling.
The inner diameter of the proximal tubules in the
control group was 43.01±0.01 µm. In the first trimester,
this reduced to 36.2±1.01 µm, a 1.2-fold decrease,
primarily due to enlargement of epithelial cells. In the
second trimester, the diameter was 37.1±1.01 µm,
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indicating a 1.15-fold reduction, with less pronounced
changes with age.
In the third trimester, the inner diameter was
39.2±1.01 µm, showing a 1.1-fold decrease compared
to the control group, but this difference was not
statistically significant.
Regarding the distal tubule diameter, it measured
61.12±1.4 µm in the control group, while in the first
trimester, it reached 84.36±12.50 µm. This increase
reflects tubular enlargement and corresponds with the
presence of dystrophic and necrobiotic changes in the
epithelium.
In the second trimester, the distal tubule diameter was
78.14±1.6 µm, 1.3 times larger than in the control
group. In older individuals (ages 60
–
74), this
measurement averaged 68.11±1.3 µm, which is 1.11
times larger than controls, although the difference was
statistically insignificant. These findings indicate that
age-related reductions in adaptive capacity contribute
to a lesser degree of change in the distal tubules
CONCLUSIONS
Multiplex morphometric studies revealed that age-
related renal damage indicators were significantly
elevated in all study groups compared to the control
group. In the first trimester of pregnancy,
morphofunctional
parameters
were
markedly
elevated, with more pronounced damage observed. On
average, the size of all renal components increased by
up to 1.35 times relative to the control group, reflecting
vascular dilation and overall morphological dominance
of injury features, making this the most affected group.
In the second trimester, these parameters were, on
average, up to 1.2 times higher than in the control
group. This was explained by weaker rapid
morphological adaptation mechanisms and a decline in
vascular component responsiveness due to age-related
changes. In this group, renal damage indicators showed
10
–
15% variability compared to the control group,
confirming moderate but notable pathological
differences.
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