For clarifying the pathogenesis of the acute renal failure which is regarded as one of the most important complications in the patients who died in the ICU and CCU, the histopathological study of the renal lesions has been performed in this communication and the results obtained were as follows:
1) There was no typical case of classifical lower nephron nephrosis (LNN) type I in this study. However, a few cases of LNN type II revealed interstitial focal edema-fibrosis variant were obserbed. Incidentally in both group striking anemia in intra-renal vasculature constitutes the common features.
2) Approximately 8% of the LNN type I group associated with shock kidney (SK) type III which suggested the alteration, of renal change resulted from incorporation of intensive care medical units.
3) The author failed to observe the osmotic nephrosis which was anticipated by the massive infusional therapy and majority of them disclosed focal nephrotic type. Moreover, no case of renal hemosiderosis is encountered. This fast also may support a view that the changes of the renal lesions have been alterated remarkably after incorporation of infusional therapy based on theoretical back ground.
4) In the entity of specific varities, intra-glomerular stasis, intra-glomerular micro-thrombosis formation, acute renal infarction, renal cortical necrosis, renal vascular paralysis, acute tubular necrosis and renal, or pen-pelvic hemorrhages are frequently observed. Majority of them manifested clinical symptomes of acute renal failure. Moreover, it is of noteworthy that the marked increase of the intra-glomerular micro-thrombosis is observed recently, which also supports the view of alteration of renal lesions after installation of critical care units.
5) In the entity of renal cortical necrosis, renal pre-infarction or renal pre-cortical necrosis which may reflect the extremely acute cases of renal impairment.
6) The renal or pen-pelvic hemorrhages are frequently observed in various underlying disease conditions. This fact is justified as one of the most noteworthy pathological changes which suggest the causation of severe shock conditions.