Patients with lead poisoning may develop intranuclear inclusions within renal tubular epithelial cells. These cells can be identified in the urine sediment.
Diagnostic features:
(1) Dense inclusions with an adjacent zone of clearing are seen within the nuclei of affected epithelial cells lining the proximal renal tubules.
(2) The inclusions are acid-fast.
(3) The inclusions are positive when immunostained with antibodies to p32/6.3.
(4) Exclusion of other causes of intranuclear inclusions (CMV, etc).
The inclusions are complexes of lead with p32/6.3, a nuclear matrix protein that is present in the brain within both neurons and astrocytes.
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