Glomerular Tubular Reflux-A Morphologic Renal Lesion Associated with the Hepatorenal Syndrome
✍ Scribed by Gary C. Kanel; Robert L. Peters
- Publisher
- John Wiley and Sons
- Year
- 1984
- Tongue
- English
- Weight
- 568 KB
- Volume
- 4
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
The hepatorenal syndrome, a primary cause of death from acute and chronic liver disease, consists of a functional renal failure whereby examination of the kidney has previously shown no distinct or specific morphologic change. We describe an unusual renal lesion consisting of the reflux of proximal convoluted tubular epithelium into Bowman's space. An autopsy series shows this glomerular change to be present in 71.4% of cases with the hepatorenal syndrome, while only present in 0 to 27.3% in other autopsy categories (p < 0.001). Since this lesion has been previously described with experimental renal ischemic change and terminal hypotension, it is possible that it is caused in part by the decreased or altered renal blood flow known to be associated with the hepatorenal syndrome.
One of the major precipitating causes of death in patients with liver failure is a functional renal failure, consisting of the insidious onset of azotemia and oliguria, often with tense ascites and extremely low urinary sodium concentrations, in the absence of any usual cause of renal failure. This has been termed the hepatorenal syndrome, and to date there has not been identified an associated distinct morphologic renal lesion (1-3).
Over the past few years, we have noticed an unusual glomerular lesion in patients dying in hepatic failure, consisting of the reflux of proximal convoluted tubular epithelium into Bowman's space. This change has been previously described in various clinical and experimentally induced renal injuries, but not in the hepatorenal syndrome (4-12). We presently describe this glomerular tubular reflux (GTR), and report an autopsy series of patients who died with and without liver disease, to establish the incidence of this lesion, and possible significance, in patients with the hepatorenal syndrome.
Methods
Hematoxylin and eosin stains of kidney sections from all 135 autopsies performed at John Wesley County