ON HUMAN FETUSES ASSOCIATED WITH MALFORMATIONS OF THE HEART AND GREAT VESSELS, AND CONGENITAL SCLEROSIS OF THE GROMERULI IN THE NEWBORN

Abstract

The pathogenetic relationship between so-called congenital glomerulosclerosis of the kidney and developmental anomalies of the heart and great vessels was studied histopathologically. For this purpose 58 human fetuses and newborns associated with cardiovascular anomalies were used. Fursher, 54 human fetuses and newborns were employed as the controls. These fetuses and newborns aged 5 months of gestation to 20 days after birth. The cardiovascular anomalies were clssified into four groups: 1) Hypoplasia of the aorta isolated and combined with ventricular septal defect, in part, including Eisenmenger's complex, 2) the aorta and pulmonary trunk of equal size complicated with ventricular septal defect and, in part, including Eisenmenger's complex, 3) hypoplasia or aplasia of the pulmonary trunk including Fallot's tetralogy and 4) anomalies of the valves, transposition of the great vessels and others. Microscopic findings of the kidney, particularly in relation to glomerulosclerotic changes were examined among these groups of cardiovascular anomalies. Hematoxylin-eosin, Mallory, Weigert and van Gieson stains, and when necessary, PAS, sudan III stain and Lilie's impregnation were made. The results wereas follows: 1) In the controls no glomerulosclerosis of the kidney was found up to the 7th month of gestation, but there were I case of glomerulosclerosis ofthe kidney respectively in. the 9th month of gestation and after birth. The newborn infants aged less than 7 days showed interstitial congestion and slight degeneration of the uriniferous epithelium frequently as compared with the fetuses. 2) Generally the appearance of glomerulosclerosis of the kidney in the fetal, especially in the neoratal period was remarkable when cardiovascular anomalies were associated. 3) When cardiovascular anomalies were combined with other organ anomalies, the incidence of glomerulosclerosis of the kidney was slightly higher than that in cardiovascular anomalies alone. 4) According to the groups of cardiovascular anomalies such as classified above, the occurrence of glomerulosclerosis of the kidney was found to be as follows: 1) most frequent in hypoplasia of the aorta combined with or without ventricular septal defect (69.6%), 2) less frequent in the aorta and pulmonary trunk of equal size and other anomalies (61.1-62.5%), but 3) hardly detected in hypoplasia or aplasia of the pulmonary trunk except for complicated with renal hypoplasia which caused glomerulosclerosis of the kidney in 55.5%. The formation of the intrarenal arteries is closely connected with the growth of the kidney and related hemodynamic shift of general blood circulation, and in cosequence, depends upon the correlation between a maturation of the glomeruli and an increase of circulating blood volume into the kidney. It is noted that hemodynamic circulation of fetus and newborn is not only different from that of adult but also varies according to the kinds and grades of developmental anomalies of the heart and great vessels. Based upon these above-mentioned results, it is pointed out that a hemodynamic vicissitude of blood circulation due to developmental anomalies of the heart and great vessels throuhgout fetal to neonatal period possibly play a major role in pathogenesis of congenital glomerulosclerosis of the kidney in human fetus and newborn.