《Slide 131.》Tubular necrosis with severe shock, Kidney

A. Brief Descriptions： 

1. Acute renal failure: pre-renal, renal, post-renal. 

2. Acute tubular necrosis (patterns):

   (1) Toxic: obvious necrosis of tubular cells.

   (2) Ischemic: vasomoter nephropathy(ATN).

B. Gross Findings：

1. Early: enlarged, swelling, widened & pale cortex, congested & darked medulla.

2. Late: varied.

C. Micro Findings：

1. 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.

D. Others:

1. Clinical: many granular casts in urine.

E. Reference：

1. Robbins Pathologic Basis of Disease, 6^th 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.