PATHO-HISTOLOGICAL STUDY ON INTRA-RENAL VASCULAR CHANGES IN PYELONEPHRITIS

Abstract

The vascular changes in renal cortex and medulla in 52 human kidneys of pyelonephritis were studied optical microscopically, electron microscopically, and microangiographically.
In addition, the intrarenal vascular changes in pyelonephritis were discussed in connection with hypertension. Cases were sub-divided into 3 according to their histological findings of pyelonephritis and into 2 based on their clinical blood pressure.
In acute or subacute pyelonephritis, there were little remarkable changes of renal artery in cortex and medulla and there was no finding of acute arteritis.
In chronic pyelonephritis, there were arteriosclerotic changes corresponding to the histological changes of interstitium.
In the severe cases of chronic pyelonephritis, the sclerotic changes in the cortex were stronger in arteria, and in arteriola than their ages, but particularly there was no acute severe changes such as fibrinoid necrosis.
Such findings will be explained by the slow deterioration of the vascular system in the cortex based on the interstitial fibrosis of pyelonephritis.
In the cases of hypertension, the vascular changes seemed to be stronger than those of normal blood pressure, but it was very difficult to point out the characteristic, morphological findings in the cases of hypertension. In pyelonephritis, there were very few cases of hypertension.
It seemed to be depended upon the far less findings of arteriolosclerosis in pyelonephritis than in glomerulonephritis or malignant nephrosclerosis.
According to the microangiographic findings of the severe cases of chronic pyelonephritis, the direct connections of afferent and efferent arterioles of glomerulus were revealed: the blood supply of the medulla, seemed better than expected.
Patho-histologically, the arteriolae rectae became narrow in such cases, and electron microscopically the atrophy of tunica media and the abnormal changes of basement membrance became revealed.
Such findings might be explained by the disturbance of blood supply in medulla in the severe cases off chronic pyelonephritis.