結石腎の病態 第2編: 結石腎の病理学的観察

Abstract

Patho-anatomical observations in relation to function and m orphology have been made on 60 cases of kidney with calculus removed surgically at our clinic and affiliated hospitals during the period of last 5 years. The degree of macroscopic c h anges are classified into A, B, C, D, E, and F in which A represents slight changes and F represents the most severe changes. Among 60 cases, 5 cases fall in A, 16 cases in B, 10 cases in C, 11 cases in D, 7 cases in E, and 11 cases in F. Microscopically, even in the site where presents little macroscopic changes, dilatation, degeneration, clasmatosis, or hydronephrotic change of nephrotic duct were observed and hyperemia and cell infiltration were also found in glomerulus. As renal changes got more severe, the changes in nephrotic duct became marked and finally the duct became to show hyaline degeneration and cystic formation. While in glomerulus, such epithelial crescent formation and hyaline degeneration as seen in chronic nephritis were appeared. In interstice various changes, such as proliferation of connective tissue, cellular infiltration, capillary filling and bleeding, arteriolar sclerosis, atrophy in aseptic case, and inflammatory picture in infected case, were noted. The mucous membrane of the renal pelvis showed epithelial hypertrophy or squamatization, exfoliation and ulceration of epithelium, edema and bleeding or hyperemia in tunica propria-submucous coat, and appearance of lymph folicle in submucous coat. The author also described typical histological findings on 23 cases, among which the most significant changes in calculous pelvis were squamatization in 3 cases (5%), and papillomatous proliferation of transitional epithel in 1 case (1.6%). The relationship between function and morphology of the kidney with calculus has been studied on 20 cases at our clinic. It became clear that there are some relationship between function and the degree of pathological changes of glomerulus and nephrotic duct. As the degree of pathological changes of glumerulus and nephrotic duct got more severe, higher value of minimum specific gravity of urine in dilution test, lower value of maximum specific gravity of urine in concentration test, and a decrease in dye excretion at 15th minute in PSP test were observed. Macroscopic changes in the kidney with calculus and indigocarmine excretion test were studied on 50 cases at our clinic. Reduction and disappearance of dye excretion were observed in 44 cases (88%), though in 6 cases (12%) these results did not coincide with affected side. Therefore, it is more likely that renal function tests do not always represent the degree of pathological changes of the kidney. In regard to the relationship between prolife r ation of connective tissue and renal function, as proliferation of connective tissue became more marked, changes in glomerulus and nephrotic duct were generally became more significant. Therefore, it is clear that dysfunction of these kidneys were more severe and there are a certain relationship between proliferation of connective tissue and renal function.