Histopathological studies of the chronic uremic patients treated with intermittent peritoneal and hemodialysis

Abstract

1, Peritoneal Dialysis.Twenty-eight autopsy cases, including 25 cases of chronic glomerulonephritis, one case of malignant: nephrosclerosis, 2 cases of chronic pyelonephritis were used for this study. The similar number cases without dialysis were also used as control. Histopathological findings were obtained as follows.(1). Renal contraction were remarkable in patients of chronic glomerulonephritis, especially, in long-termm dialysed ones. Nevertheless, completely-hyalinized glomeruli decreased in number, and on the contrary, in partially-hyalinized ones mesangeal cells were preserved rather well. Edema, plasma imbibition and fatty deposits were also seen in those glomeruli. Even the scarred glomeruli were mostly stained slightly red with Van-Gieson' staining and frequently violett-blue by Mallory' staining.(2). The renal arteriolar wall showed marked edema in the intima with proliferation of argentfile and collagen fibers, that resembled the one in malignant nephrosclersis without dialysis. But proliferation of elastic fibers and atrophy of media were seen prominent in malignant nephrosclerosis.(3). The basementmembrane of the tubules were splattered and irregularly thickened. There were irregularlyshaped crystals and metastatic calcification in the tubular lumen.(4). Uremic pneumonitis were found in 87.5 percent of the non-dialysed patients and in 68.7 percent of the patients dialysed less than three months. It was not seen in most cases dialysed more than four months. Few of the long-term dialysed cases showed focal organization of alveolar exsudates due to uremic pneumonitis.(5). Pleuritis and pericarditis were observed in most of the dialysed patients, pericarditis was frequently fibrinofibrous with organization, on the contrary, that of non-dialysed cases were fibrinous type. At that time, marked pericardial effusion was occationally noticed, it was bloody in few cases.(6). Angitis with fibrinoid necrosis was seen in every organ. Two cases showed gastrointestinal ulcer with angitis and died from bleeding of the ulcer. The another two cases revealed respectively angitis of cerebral arterioles associated with hemorrhage and of pancreatic interstitial arterioles.It was characteristic in dialysed patients that edema or edematous sclerosis were observed in glomeruli, interstices and intima of arterioles.As the factors to increase the peamiability of the arteriolar wall, the changes of blood-pressure, the decrease of serum albumin and non-protein-nitrogen and the changes of serum electrolyte through peritoneal dialysis were considered. Edema of the intima of arterioles was remarkably seen in the cases showing marked. decrease of serum albumin and non-protein-nitrogen and in the cases which had much dialysates in oneJ dialysis and urin volume of less than 100ml a day.