Skip to main content
PMC home page
The American Journal of Pathology logoLink to The American Journal of Pathology
. 1984 Aug;116(2):253–261.

Outer medullary circulatory defect in ischemic acute renal failure.

K Yamamoto, D R Wilson, R Baumal
PMCID: PMC1900543  PMID: 6465286

Abstract

Changes in medullary circulation may contribute significantly to the pathogenesis of ischemic acute renal failure. The microcirculation of the outer medulla of the rat kidney was studied by morphometry, carbon injection, and scanning electron microscopy of vascular casts after temporary renal ischemia. Morphometry showed a markedly reduced vascular area and an increased tubular epithelial cell area in the outer stripe of the medulla 2 hours after blood reflow. Maximum diminution in vascular area occurred 24-48 hours after reflow, with swollen and later necrotic tubular epithelium compressing the surrounding vascular compartment. Outflow blockade of venous vasa recta in the outer stripe caused congestion of the inner stripe. Carbon injection and scanning electron microscopy of vascular casts confirmed the perfusion defects of the outer stripe. These results suggest that decreased blood reflow to the outer stripe of the medulla secondary to tubular epithelial cell swelling and necrosis plays a significant role in the pathogenesis of ischemic acute renal failure in the rat.

Full text

PDF
253

Images in this article

255Figure 1
on p.255
257Figure 3
on p.257
257Figure 4
on p.257
258Figure 5
on p.258
258Figure 6
on p.258
259Figure 7
on p.259

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrews P. M., Coffey A. K. Factors that improve the preservation of nephron morphology during cold storage. Lab Invest. 1982 Jan;46(1):100–120. [PubMed] [Google Scholar]
  2. Andrews P. M., Coffey A. K. Protection of kidneys from acute renal failure resulting from normothermic ischemia. Lab Invest. 1983 Jul;49(1):87–98. [PubMed] [Google Scholar]
  3. Arendshorst W. J., Finn W. F., Gottschalk C. W. Pathogenesis of acute renal failure following temporary renal ischemia in the rat. Circ Res. 1975 Nov;37(5):558–568. doi: 10.1161/01.res.37.5.558. [DOI] [PubMed] [Google Scholar]
  4. Best J., Lavender J. P., Russell S., Sherwood T. Preservation of normal cortical vasculature in ischaemic renal failure in the dog. Nephron. 1976;16(3):188–196. doi: 10.1159/000180601. [DOI] [PubMed] [Google Scholar]
  5. Burke T. J., Arnold P. E., Schrier R. W. Prevention of ischemic acute renal failure with impermeant solutes. Am J Physiol. 1983 Jun;244(6):F646–F649. doi: 10.1152/ajprenal.1983.244.6.F646. [DOI] [PubMed] [Google Scholar]
  6. Cox J. W., Baehler R. W., Sharma H., O'Dorisio T., Osgood R. W., Stein J. H., Ferris T. F. Studies of the mechanism of oliguria in a model of unilateral acute renal failure. J Clin Invest. 1974 Jun;53(6):1546–1558. doi: 10.1172/JCI107705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Diethelm A. G., Wilson S. J. Obstruction to the renal microcirculation after temporary ischemia. J Surg Res. 1971 Jun;11(6):265–276. doi: 10.1016/0022-4804(71)90100-4. [DOI] [PubMed] [Google Scholar]
  8. Donohoe J. F., Venkatachalam M. A., Bernard D. B., Levinsky N. G. Tubular leakage and obstruction after renal ischemia: structural-functional correlations. Kidney Int. 1978 Mar;13(3):208–222. doi: 10.1038/ki.1978.31. [DOI] [PubMed] [Google Scholar]
  9. Flores J., DiBona D. R., Beck C. H., Leaf A. The role of cell swelling in ischemic renal damage and the protective effect of hypertonic solute. J Clin Invest. 1972 Jan;51(1):118–126. doi: 10.1172/JCI106781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Frega N. S., DiBona D. R., Guertler B., Leaf A. Ischemic renal injury. Kidney Int Suppl. 1976 Oct;6:S17–S25. [PubMed] [Google Scholar]
  11. Frega N. S., DiBona D. R., Leaf A. The protection of renal function from ischemic injury in the rat. Pflugers Arch. 1979 Aug;381(2):159–164. doi: 10.1007/BF00582347. [DOI] [PubMed] [Google Scholar]
  12. Gaudio K. M., Taylor M. R., Chaudry I. H., Kashgarian M., Siegel N. J. Accelerated recovery of single nephron function by the postischemic infusion of ATP-MgCl2. Kidney Int. 1982 Jul;22(1):13–20. doi: 10.1038/ki.1982.126. [DOI] [PubMed] [Google Scholar]
  13. Glaumann B., Trump B. F. Studies on the pathogenesis of ischemic cell injury. III. Morphological changes of the proximal pars recta tubules (P3) of the rat kidney made ischemic in vivo. Virchows Arch B Cell Pathol. 1975 Dec 19;19(4):303–323. [PubMed] [Google Scholar]
  14. Griffith L. D., Bulger R. E., Trump B. F. The ultrastructure of the functioning kidney. Lab Invest. 1967 Feb;16(2):220–246. [PubMed] [Google Scholar]
  15. Karlberg L., Källskog O., Norlén B. J., Wolgast M. Nephron function in postischemic acute renal failure. Scand J Urol Nephrol. 1982;16(2):167–172. doi: 10.3109/00365598209179748. [DOI] [PubMed] [Google Scholar]
  16. Karlberg L., Källskog O., Nygren K., Wolgast M. Erythrocyte and albumin distribution in the kidney following warm ischemia. A study in rats. Scand J Urol Nephrol. 1982;16(2):173–177. doi: 10.3109/00365598209179749. [DOI] [PubMed] [Google Scholar]
  17. Kreisberg J. I., Mills J. W., Jarrell J. A., Rabito C. A., Leaf A. Protection of cultured renal tubular epithelial cells from anoxic cell swelling and cell death. Proc Natl Acad Sci U S A. 1980 Sep;77(9):5445–5447. doi: 10.1073/pnas.77.9.5445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kriz W. Structural organization of renal medullary circulation. Nephron. 1982;31(4):290–295. doi: 10.1159/000182669. [DOI] [PubMed] [Google Scholar]
  19. Mason J., Olbricht C., Takabatake T., Thurau K. The early phase of experimental acute renal failure. I. Intratubular pressure and obstruction. Pflugers Arch. 1977 Aug 29;370(2):155–163. doi: 10.1007/BF00581689. [DOI] [PubMed] [Google Scholar]
  20. Mason J., Welsch J., Takabatake T. Disparity between surface and deep nephron function early after renal ischemia. Kidney Int. 1983 Jul;24(1):27–36. doi: 10.1038/ki.1983.122. [DOI] [PubMed] [Google Scholar]
  21. Maunsbach A. B. The influence of different fixatives and fixation methods on the ultrastructure of rat kidney proximal tubule cells. I. Comparison of different perfusion fixation methods and of glutaraldehyde, formaldehyde and osmium tetroxide fixatives. J Ultrastruct Res. 1966 Jun;15(3):242–282. doi: 10.1016/s0022-5320(66)80109-0. [DOI] [PubMed] [Google Scholar]
  22. Norlén B. J., Engberg A., Källskog O., Wolgast M. Intrarenal hemodynamics in the transplanted rat kidney. Kidney Int. 1978 Jul;14(1):1–9. doi: 10.1038/ki.1978.84. [DOI] [PubMed] [Google Scholar]
  23. Oken D. E. Acute renal failure (vasomotor nephropathy): micropuncture studies of the pathogenetic mechanisms. Annu Rev Med. 1975;26:307–319. doi: 10.1146/annurev.me.26.020175.001515. [DOI] [PubMed] [Google Scholar]
  24. ROLLHAEUSER H., KRIZ W., HEINKE W. DAS GEFAESS-SYSTEM DER RATTENNIERE. Z Zellforsch Mikrosk Anat. 1964 Oct 23;64:381–403. [PubMed] [Google Scholar]
  25. Riley A. L., Alexander E. A., Migdal S., Levinsky N. G. The effect of ischemia on renal blood flow in the dog. Kidney Int. 1975 Jan;7(1):27–34. doi: 10.1038/ki.1975.4. [DOI] [PubMed] [Google Scholar]
  26. SHEEHAN H. L., DAVIS J. C. Renal ischaemia with failed reflow. J Pathol Bacteriol. 1959 Jul;78:105–120. [PubMed] [Google Scholar]
  27. Siegel N. J., Gunstream S. K., Handler R. I., Kashgarian M. Renal function and cortical blood flow during the recovery phase of acute renal failure. Kidney Int. 1977 Sep;12(3):199–204. doi: 10.1038/ki.1977.101. [DOI] [PubMed] [Google Scholar]
  28. Solez K., Ideura T., Silvia C. B., Hamilton B., Saito H. Clonidine after renal ischemia to lessen acute renal failure and microvascular damage. Kidney Int. 1980 Sep;18(3):309–322. doi: 10.1038/ki.1980.141. [DOI] [PubMed] [Google Scholar]
  29. Stein J. H., Lifschitz M. D., Barnes L. D. Current concepts on the pathophysiology of acute renal failure. Am J Physiol. 1978 Mar;234(3):F171–F181. doi: 10.1152/ajprenal.1978.234.3.F171. [DOI] [PubMed] [Google Scholar]
  30. Summers W. K., Jamison R. L. The no reflow phenomenon in renal ischemia. Lab Invest. 1971 Dec;25(6):635–643. [PubMed] [Google Scholar]
  31. Tanner G. A., Sloan K. L., Sophasan S. Effects of renal artery occlusion on kidney function in the rat. Kidney Int. 1973 Dec;4(6):377–389. doi: 10.1038/ki.1973.134. [DOI] [PubMed] [Google Scholar]
  32. Thiel G., de Rougemont D., Kriz W., Mason J., Torhorst J., Wolgast M. The role of reduced medullary perfusion in the genesis of acute ischemic renal failure. Summary of a round-table discussion. Nephron. 1982;31(4):321–323. doi: 10.1159/000182674. [DOI] [PubMed] [Google Scholar]
  33. Venkatachalam M. A., Bernard D. B., Donohoe J. F., Levinsky N. G. Ischemic damage and repair in the rat proximal tubule: differences among the S1, S2, and S3 segments. Kidney Int. 1978 Jul;14(1):31–49. doi: 10.1038/ki.1978.87. [DOI] [PubMed] [Google Scholar]
  34. WAINWRIGHT J. Tubular necrosis following temporary occlusion of the renal artery in the rat. Br J Exp Pathol. 1950 Jun;31(3):400–404. [PMC free article] [PubMed] [Google Scholar]
  35. Weibel E. R. Stereological principles for morphometry in electron microscopic cytology. Int Rev Cytol. 1969;26:235–302. doi: 10.1016/s0074-7696(08)61637-x. [DOI] [PubMed] [Google Scholar]
  36. Williams R. H., Thomas C. E., Navar L. G., Evan A. P. Hemodynamic and single nephron function during the maintenance phase of ischemic acute renal failure in the dog. Kidney Int. 1981 Apr;19(4):503–515. doi: 10.1038/ki.1981.48. [DOI] [PubMed] [Google Scholar]
  37. Wolgast M., Karlberg L., Källskog O., Norlén B. J., Nygren K., Ojteg G. Hemodynamic alterations in ischaemic acute renal failure. Nephron. 1982;31(4):301–303. doi: 10.1159/000182671. [DOI] [PubMed] [Google Scholar]
  38. de Rougemont D., Brunner F. P., Torhorst J., Wunderlich P. F., Thiel G. Superficial nephron obstruction and medullary congestion after ischemic injury: effect of protective treatments. Nephron. 1982;31(4):310–320. doi: 10.1159/000182673. [DOI] [PubMed] [Google Scholar]

Articles from The American Journal of Pathology are provided here courtesy of American Society for Investigative Pathology

RESOURCES