Morphological variation of the kidneys with its pathological relevance

Kidneys are bean shaped organs with the length of 11cms, breadth of 6cms and thickness of 3cms in antero­ posterior dimension. Variations in morphology of the kidneys are either congenital or acquired. The present paper deals with two cases with abnormal morphology. During routine dissection of abdomen for the under graduate students in MVJ Medical College, Bengaluru, it was found that there were kidneys with morphological variations in two cadavers. Both these specintens were analysed morphologically and sent for histopathological examination. The specinten No: 1 was a case of Ask Upmark kidney and Specinten No: 2 was a case of Granular contracted kidney. Morphological changes in kidney could be congenital or acquired. It is usually associated with various pathologies of kidneys. The pathogenesis is controversial attributed to vesicoureteric reflux with intrarenal reflux or localised developmental arrest, arteriolar nephrosclerosis and glomerulonephritis. The morphology and histopathology of the cases have been discussed.

Serum Creatinine and Urine Microalbumin Level in Hypertensive and Non hypertensive Patients.

Introduction: Hypertension is one of the most common cardiovascular disorders, more likely to accelerateatherosclerosis causing cardiovascular complications and benign arteriolar nephrosclerosis for an extendedperiod of time may manifest as a mild to moderate elevation of serum creatinine and/or microalbuminuria.Methods: The present study was carried out on total 100 subjects. Which were divided into two groups. Firstgroup of experimental group consist of 50 subjects with known Hypertensive Subjects. Another group is controlgroup consist of 50 Non-Hypertensive Subjects with no present and past family history of hypertension.Results: The serum creatinine and microalbuminuria were estimated, compared and correlated in hypertensivecase group with healthy normotensive group. In case group there was signiÞ cantly elevated urine microalbuminand serum creatinine levels when compared to controls and also signiÞ cant positive correlation betweenserum creatinine and urine microalbumin levels in case group (hypertensive) as compared to control (nonhypertensive) groupConclusions: In the present study it has concluded that in Hypertensive patients serum creatinine, urinemicroalbumin is stastistically elevated in subjects group when compared to the control group.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12923

Increased Fibrinogen Levels and Hemostatic Abnormalities in Patients with Arteriolar Nephrosclerosis: Association with Cardiovascular Events

SummaryIncreased plasma fibrinogen levels and hemostatic abnormalities suggestive of a prothrombotic state are present in patients with endstage renal failure and could contribute to increased cardiovascular morbidity in these patients. We investigated the relationship between abnormalities of the hemostatic system and the degree of renal failure and whether these abnormalities are associated with increased prevalence of cardiovascular events in patients with arteriolar nephrosclerosis. In 425 patients recruited at a hypertension clinic we assessed the renal function by creatinine clearance, urinary protein excretion, and microalbuminuria, the prevalence of atherosclerotic disease, and measured prothrombin time, activated partial thromboplastin time, fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer, and antithrombin. Early impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) caused by arteriolar nephrosclerosis was found in 172 patients. Patients with early renal failure were significanly older and had significantly greater values of blood pressure, plasma fibrinogen, F1+2, and D-dimer than patients with normal renal function. Elevated D-dimer and fibrinogen levels were independently associated with the presence of decreased creatinine clearance. Log fibrinogen, log F1+2, and log D-dimer were inversely correlated with creatinine clearance. The prevalence of coronary artery, cerebrovascular, and peripheral vascular disease was significantly greater in patients with mild renal failure than in those with normal renal function. Elevated levels of fibrinogen and D-dimer were associated with the presence of atherosclerotic disease independent of renal function and other risk factors. In conclusion, changes in hemostatic parameters occur early in the course of renal failure in patients with arteriolar nephrosclerosis, suggesting a prothrombotic state that may contribute to the risk for atherosclerotic disease at all levels of renal function.

Exercise-induced acute renal failure associated with ibuprofen, hydrochlorothiazide, and triamterene.

Nonsteroidal anti-inflammatory drugs predispose to acute renal failure in conditions associated with decreased RBF. Such conditions include advanced age, hypertension, chronic renal insufficiency, diuretic use, and any condition decreasing effective circulating volume. Strenuous exercise also causes marked reductions in RBF. The patient discussed developed severe acute renal failure after strenuous exercise and therapeutic doses of ibuprofen and hydrochlorothiazide-triamterene. Urinalysis showed a nephritic sediment with red blood cell casts. Renal biopsy showed acute tubular necrosis and arteriolar nephrosclerosis. Although exercise-associated acute renal failure is uncommon, susceptible patients with exercise-induced renal ischemia and prostaglandin inhibition may develop this complication.

Age-related non-neoplastic lesions in the heart and kidneys of Syrian hamsters of the APA strain

Spontaneous cardiac and renal lesions in APA hamsters were examined histopathologically. Myocardial degeneration, valvular thickening, coronary arterial degeneration and increase in heart weight were common in old hamsters. These changes, which suggest cardiac failure, seem to be related to cardiac thrombosis which predominantly affected the left atrium and was found in over 40% of each sex over 16 months of age. Neither glomerular amyloidosis nor arteriolar nephrosclerosis was detected. In general the histopathology of renal lesions in APA hamsters resembled that of the condition known as glomerulonephrosis in rats. Renal lesions occurred more frequently and more severely and developed more rapidly in females than in males. There was no apparent correlation between cardiac thrombosis and renal disease.

Arteriolar Nephrosclerosis in the Syrian Hamster

Syrian hamsters developed spontaneous renal lesions that resembled those of arteriolar nephrosclerosis in man, and differed from other spontaneously occurring or virus-induced renal diseases in other rodent species. Morphologic changes were mainly degenerative with little cellular exudation and were associated with histologic changes in the intrarenal vasculature. The renal lesions were progressive, often fatal and sometimes were complicated by glomerular amyloidosis with the nephrotic syndrome and uremia. Endstage kidneys often had fibrinoid necrosis of intrarenal arterioles and thus resembled lesions characteristic of the malignant phase of human essential hypertension. Fibrinoid necrosis of small arterioles was common in the uterus, ovaries or testes of affected animals; it was less frequent in mesenteric or coronary vessels. Cardiac thrombosis, often involving the left atrium or left atrioventricular valves, also was common. Changes occurred earlier and often were more severe in females than in males. This disease was a major cause of morbidity and mortality and hampered life-span studies.