Abstract
Two variants of nephrosclerosis, roughly corresponding to the arterial and the arteriolar forms, have been examined in a series of autopsy kidneys by five observers using quantitative morphometry. These two variants are both marked by fibroplastic intimal thickening and medial wastage in the arteries, but one of these affects vessels of sizes that are closer to the heart, whereas the other affects sizes that are more remote from the source of arterial pressure. Both types of nephrosclerosis were found to increase with aging in subjects without hypertension. Each year of aging added 0.15 units of intimal thickening to the close vessels and 0.11 to the remote vessels. Each millimeter of mercury of elevated blood pressure was equivalent to 1 year of aging in the close and 2 years in the remote levels of the arterial tree. The four variables, age, blood pressure, remote level intimal thickness, and close level intimal thickness, were found to hold complex curvilinear interrelationships when examined by regression analysis. A dynamic model was suggested by the following findings: The earliest changes shown by young normotensives are in the close vessels, possibly because of the aging effect of the normal pulse wave. Later, the changes extend into the remote level, perhaps because the thickened intima is rigid and propagates the pulse wave abnormally far into the smallest arteries. Hypertension could then be viewed either as a cause for an exaggeration of this normal process or as a consequence of its extension into the remote level vessels where resistance to blood flow is greater or both. The objective morphometric method showed good agreement in the findings by independent observers and is considered to be suitable for epidemiologic studies of nephrosclerosis.
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- Branch A., Linder G. C. THE ASSOCIATION OF GENERALIZED ARTERIOLAR SCLEROSIS WITH HIGH BLOOD PRESSURE AND CARDIAC HYPERTROPHY IN CHRONIC NEPHRITIS. J Clin Invest. 1926 Dec;3(2):299–316.3. doi: 10.1172/JCI100081. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cook T. A., Yates P. O. A critical survey of techniques for arterial mensuration. J Pathol. 1972 Oct;108(2):119–127. doi: 10.1002/path.1711080205. [DOI] [PubMed] [Google Scholar]
- Joyner W. L., Davis M. J. Pressure profile along the microvascular network and its control. Fed Proc. 1987 Feb;46(2):266–269. [PubMed] [Google Scholar]
- Moritz A. R., Oldt M. R. Arteriolar Sclerosis in Hypertensive and Non-Hypertensive Individuals. Am J Pathol. 1937 Sep;13(5):679–728.7. [PMC free article] [PubMed] [Google Scholar]
- Nishi T., Bond C., Jr, Brown G., Solez K., Heptinstall R. H. A morphometric study of arterial intimal thickening in kidneys of dialyzed patients. Am J Pathol. 1979 Jun;95(3):597–610. [PMC free article] [PubMed] [Google Scholar]
- Pesonen E., Martimo P., Rapola J. Histometry of the arterial wall. A new technique with the aid of automatic data processing. Lab Invest. 1974 Apr;30(4):550–555. [PubMed] [Google Scholar]
- SOMMERS S. C., RELMAN A. S., SMITHWICK R. H. Histologic studies of kidney biopsy specimens from patients with hypertension. Am J Pathol. 1958 Jul-Aug;34(4):685–715. [PMC free article] [PubMed] [Google Scholar]
- Short D. Morphology of the intestinal arterioles in chronic human hypertension. Br Heart J. 1966 Mar;28(2):184–192. doi: 10.1136/hrt.28.2.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Strong J. P., Oalmann M. C., Newman W. P., 3rd, Tracy R. E., Malcom G. T., Johnson W. D., McMahan L. H., Rock W. A., Jr, Guzman M. A. Coronary heart disease in young black and white males in New Orleans: Community Pathology Study. Am Heart J. 1984 Sep;108(3 Pt 2):747–759. doi: 10.1016/0002-8703(84)90668-9. [DOI] [PubMed] [Google Scholar]
- Tracy R. E., Mercante D. E., Moncada A., Berenson G. Quantitation of hypertensive nephrosclerosis on an objective rational scale of measure in adults and children. Am J Clin Pathol. 1986 Mar;85(3):312–318. doi: 10.1093/ajcp/85.3.312. [DOI] [PubMed] [Google Scholar]
- Tracy R. E., Tabares Toca V. Nephrosclerosis and blood pressure. I. Rising and falling patterns in lengthy records. Lab Invest. 1974 Jan;30(1):20–29. [PubMed] [Google Scholar]
- Ueda K., Omae T., Hirota Y., Takeshita M., Hiyoshi Y. Epidemiological and clinco-pathological study on renal diseases observed in the autopsy cases in Hisayama population, Kyushu Island, Japan. J Chronic Dis. 1976 Mar;29(3):159–173. doi: 10.1016/0021-9681(76)90043-6. [DOI] [PubMed] [Google Scholar]