STUDY ON CHEMOTHERAPY FOR RENAL TUBERCULOSIS

REPORT 2. ¹³¹I-HIPPURAN DENSITY TEST AND PATHOHISTOLOGY OF RENAL TISSUE

Abstract

There are many reports on the microscopic investigation for the effect of chemotherapy against renal tubercurosis. I also reported a result of our investigation about it.
Generally speaking, antibiotic agents exert an effect only after it has reached foci in the internal organs. Contrary to the above-mentioned reports, the reports are scanty which dealt with relation between the density of the agents in the foci and the effect on the focal tissue.
In a total of fifteen cavities in thirteen cases, eight closed cavities and seven open cavities following experiment was performed; 100μc of ¹³¹I-Hippuran was injected intravenously, once three hours before nephrectomy and once at the beginning of an operation, and measured the radioactivity of ¹³¹I-Hippuran within the cavities of the kidneys after they had been removed. Further, histological investigation was made on the contents of these cavities and cavity walls. As a result, I came to the following conclusion.
1) The density of ¹³¹I-Hippuran within eight closed cavities was very low, as compared to that within open cavities, and the ratio of the former to the latter turned out to be from 1/10 to 1/200.
In two of these eight cavities, the density of ¹³¹I-Hippuran was 1/10. The walls of these two cavities were excellent in the growth of capillary vessels. Capillary vessels were not recognized in the cavity walls where the density of ¹³¹I-Hippuran was 1/200. Whether the density of ¹³¹I-Hippuran within closed cavities is high or not, seemed to have a relation to the number of capillary vessels.
In the cases to which chemotherapy was applied for a year, tubercle bacilli within the cavities and renal tissue were negative, and the density of ¹³¹I-Hippuran in the cavities was 1/10, although the cavities were closed.
Caseous substance was found in all closed cavities of eight cases, but the regeneration of the epithelium was not recognized.
The relation between the multiplication of connective tissue which wraps closed cavities and the generation of capillary vessels could not be clarified.
2) In three of seven open cavities, the density of ¹³¹I-Hippuran in them was 1; (that is, it was equal to that of bladder urine), and in the cavities which had a narrow passage into the renal pelvis, the density was about 1/10.
Regarding open cavities, if we apply chemotherapy to them for more than three months, it be possible that the cavities and cavity walls become negative for tubercle bacilli. Regeneration of epithelium can well be expected, if chemotherapy is given for more than six months.