HISTOPATHOLOGICAL STUDY OF BLOOD VESSELS AT THE HILUM OF TUBERCULOUS KIDNEY

Abstract

Using 30 cases of almost normal kidney as control the author examined histopathologically the blood vessels of the hilum in 138 tuberculous kidneys which were obtaind surgically. The presence of tubercle bacillus in the vessel wall was also investigated. In both control and diseased kidney the ages of the cases ranged from 20 years to 50 years old (average 30.2 years old in the control and 30.1 years old in the diseased kidney) and 65-70% of the cases were male.
[A] In 15 cases (50%) of the control histopathological changes of the renal vessels were observed, which were found in 11 cases both in the arteries and veins, in 2 cases in either the artery or the vein.
(1) The most prominent changes were so-called arteriosclerosis which consisted of thickening of inner membranes in 14 cases (46%) and atheromatous change in 6 cases. The increase of elastic fibers was found in 11 cases (36%) and the destruction of intermediate elastic fibers was observed in 7 cases (23%). Generally speaking, these changes were commonly slight, in degree and of course more remarkable in arteries than in veins.
(2) The more scarce finding was cell infiltration of the blood vessel wall which was observed in 7 cases (23%). The infiltrated cells consisted of lymphocytes, plasma cells, eosinophiles, basophiles with a greater number on the inner vessel wall than on the outer vessel wall. Generally speaking, these infiltrations were slight in degree and more frequently found on the inner vessel wall than on the outer vessel wall. No particular relation was noted in regards to sex and age.
(3) Both histological and cultural methods failed to reveal the presence of tubercle bacilli.
[B] In 121 cases (87%) of 138 tuberculous kidneys certain histopathological changes were observed in blood vessels at the hilum of kidney, which were found in 74 cases in both arteries and veins, in 35 cases in arteries alone and in 12 cases in veins alone.
(1) So-called arteriosclerosis was observed more frequently [89 cases (63%)] but slighter in degree than in the control. The atheromatous change was observed only in 24 cases and also the abnormal changes of elastic fibers, which were found in company with the thickening of inner membranes appeared less frequently than in the control [increase of inner elastic fibers only in 32 cases (23%) and destruction of intermediate elastic fibers also in 14 cases (10%)].
The thickening of inner membranes was slighter in degree rather in the advanced stage of tuberculous kidney and the abnormal changes of elastic fibers had also tendency to descrease in frequency as the tuberculous change of the kidney advanced. The above mentioned findings appeared of course more frequently and more seriously in the arteries than in the veins.
(2) Cell infiltration of the blood vessel wall was observed in 86 cases (62%), showing a much more frequency than the control. The cell infiltration was situated almost indentically to the control in the first stage of tuberculous kidney, but tuberculous granulations were distinctly found in 2 cases out of 89 tuberculous kidneys in the second stage and in one case out of 26 tuberculous kidneys in the last stage.
Contrary to the results of the control the infiltration of cell appeared more frequently in the outer layer than in the intermediate layer of the blood vessel wall through all stages of the kidney change, and it was found more frequently in the male than in the female in no regards to age. As in case of the control the cell infiltration was slight in degree and was found more frequently in vein than in artery.
(3) Blister tick swelling of the vas oasis on the outer membrane of the blood vessel wall appeared in 37 cases (27%) almost simultaneously in both artery and vein in no regards to sex and age. Although we could find no difference in frequency of the blister tick swelling of the vas vasis between 3 stages of tuberculous kidney, there were 3 cases of the last stage, whose fibe