THE PATHOGENESIS OF ACUTE RENAL FAILURE ASSOCIATED WITH TRAUMATIC AND TOXIC INJURY - RENAL ISCHEMIA, NEPHROTOXIC DAMAGE AND THE ISCHEMURIC EPISODE
THE PATHOGENESIS OF ACUTE RENAL FAILURE ASSOCIATED WITH TRAUMATIC AND TOXIC INJURY - RENAL ISCHEMIA, NEPHROTOXIC DAMAGE AND THE ISCHEMURIC EPISODE
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DOI：
10.1172/jci102550
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发表时间：
1951-01-01
影响因子：
15.9
通讯作者：
TRACY, A
中科院分区：
文献类型：
--
作者：
OLIVER, J;MACDOWELL, M;TRACY, A
肾单位显微解剖对肾脏病变的研究。在毒性和外伤性损伤引起的急性肾功能衰竭中，肾小管肾病的结构改变与肾功能紊乱相关，并且可以合理地解释肾功能紊乱。小管损伤有两种。第一种是肾毒性坏死，局限于肾单位的近端褶积部分，它在功能上与处理毒素有关。由于毒物是通过肾循环分布的，所以所有的肾单位都参与其中。2d型病变是由于局灶性皮质缺血引起的肾小管断裂（肾小管阻塞）。它在肾单位之间和肾单位的任何部分随机发生。在各种临床情况下发生的致死性急性肾衰竭的任何病例中，根据肾脏损伤的性质，这两种损害以不同的比例出现，是毒性的还是循环性的，还是两者兼而有之。在非毒性原因的急性肾衰竭（休克、挤压伤等）中，损害纯粹是循环性的，是涉及肾血流特别敏感区域的一般循环障碍的一部分或一个插曲。建议用缺血发作一词来描述这种并发症。这种肾循环发作也可能是严重中毒引起的全身循环紊乱的结果。由于这种巧合，急性肾衰竭的发病机制在整体上是统一的，其成员包括临床上不同的起源，如挤压伤、输血反应、产科事故和致命中毒。
A study of the renal lesions by microdissection of the nephrons. In acute renal failure related to toxic and traumatic injuries, the structural alterations which are correlated with and which may reasonably explain the functional disturbances in the kidney are those of a tubular nephropathy. Two sorts of tubule injury are encountered. The first is a nephrotoxic necrosis limited to that part of the nephron, the proximal convolution, which is functionally concerned with the handling of the poison. Since poisons are distributed by the renal circulation, all nephrons are equally involved. The 2d type of lesion is a disruption of the renal tubule (tubulorhexis) due to focal cortical ischemia. It occurs at random among nephrons and in any part of a nephron. In the kidney of any case of fatal acute renal failure arising under various clinical circumstances these 2 lesions appear in varying proportions depending on the nature of the renal insult, whether toxic or circulatory or both. In acute renal failure of non-toxic origin (shock, crush injury, etc.) the insult is purely circulatory, a part of or an episode in the general circulatory disturbance which has involved the peculiarly susceptible area of the renal blood flow. The term ischemuric episode is suggested to designate this complication. Such a renal circulatory episode also may occur as a consequence of the general circulatory disturbances of grave intoxication. From this coincidence stems the unity of pathogenesis in the group of acute renal failure as a whole the members of which include such clinically disparate origins as crush injury, transfusion reactions, obstetrical accidents and fatal poisonings.