《Slide 131.》Tubular necrosis with severe shock, Kidney
A. Brief Descriptions：
Acute renal failure: pre-renal, renal, post-renal.
Acute tubular necrosis (patterns):
(1) Toxic: obvious necrosis of tubular cells.
(2) Ischemic: vasomoter nephropathy(ATN).
B. Gross Findings：
Early: enlarged, swelling, widened & pale cortex, congested & darked medulla.
C. Micro Findings：
Main in proximal tubules:
Multiple points along the nephron with cellular vacuolation (degeneration) & necrosis.
Shedding or desquamation of cell fragments into lumen, or absence of individual tubular cells.
Wrinkled or thickened or rupture of base membrane (tubulorrhexia), or empty tubules.
Dilated tubules with flattened epithelium (loss of brush border).
Distal tubules & collecting ducts filled with hyaline or pigmented granular casts.
Edematous & infiltrated interstitium.
Congested peritubular capillaries (vasa recta).
Fibrosis in late stage.
Clinical: many granular casts in urine.
Robbins Pathologic Basis of Disease, 6th ed. p.969-971
【 Fig. 131-1 (2X)】The renal tubules shows ischemic change with shedding or desquamation of cell fragments into lumen.Glomerulosclerosis is seen in right view.
【 Fig. 131-2 (10X)】The renal tubules shows ischemic change with shedding or desquamation of cell fragments into lumen.