ELECTRON MICROSCOPIC STUDIES ON THE KIDNEY WITH UPPER URINARY TRACT OBSTRUCTION
PART II: CHANGES IN THE GLOMERULUS OF THE CLINICAL CASES (HYDRONEPHROSIS)
1968 Volume 59 Issue 11 Pages 981-1007
Details
1968 Volume 59 Issue 11 Pages 981-1007
Thirty-five kidneys with upper urinary tract obstruction due to various causes were studied electron-microscopically. Biopsy was made on the kidney cortex and the changes of glomerulus were studied.
The results are summarized as follows:
1) Changes in glomerular epithelial cells: Proliferation was observed in many of congenital origins and a change of the pedicles was much related to proteinuria.
Changes in glomerular endothelial cells were very little.
Changes in the capillary basement membrane: Thickening was accompanied by winding in many cases, the thickest being 1.4μ. (I defined thickness over 4000Å as thickening.)
The glomerulus with severe hyaline degeneration light-microscopically was observed electrom-microscopically to retain the form of the basement membrane.
Changes in mesangium: Proliferations of various degrees were observed in thirty three cases.
Changes in Bowman's capsule: Thickening above the grade (++) was observed in thirteen cases and the thickest was 6μ. (I defined thickness over 10000Å as thickening.)
2) Changes related to the cause of upper urinary tract obstruction: Severe changes were observed in the retrocaval ureter, infiltration of carcinoma uteri and renal stone.
3) Changes related to the site of upper urinary tract obstruction: The nearer to kidney pelvis obstruction was, so severe as the changes were.
4) Changes related to proteinuria: Many changes of glomerular epithelial cells, especially of the pidicles and capillary basement membrane were observed in the cases of proteinuria.
5) Changes related to hypertension (above max. B. P. 150mmHg): Thickening of glomerular capillary basement membrane was observed and membrane-like material was produced.
6) Changes related to infections of the urinary tract: Changes were severe in the cases which were accompanied by or had undergone infections of the urinary tract. Proliferation of the mesangium and thickening of the basement membrane and Bowman's capsule were observed.
7) Changes related to renal function: Changes were found to correspond with the findings of I. V. P. In the cases of severe renal dysfunction, proliferation of the mesangium, thickening of the basement membrane and proliferation of the endothelial cells were observed.
8) Some of other special observations by electron-microscopy are also reported.
