Intensive Care Medicine

, Volume 36, Issue 3, pp 471–478 | Cite as

Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration

  • Nicolas Lerolle
  • Dominique Nochy
  • Emmanuel Guérot
  • Patrick Bruneval
  • Jean-Yves Fagon
  • Jean-Luc Diehl
  • Gary Hill
Original

Abstract

Purpose

Septic shock is one of the leading causes of acute kidney injury. The mechanisms of this injury remain mostly unknown notably because of the lack of data on renal histological lesions in humans.

Methods

Kidney biopsy was performed immediately post-mortem in consecutive patients who died of septic shock. Comparisons were made with specimens from eight patients who died of trauma on scene and nine ICU patients that died of non-septic causes.

Results

Nineteen septic patients were included, 11 were male, and age was 72 ± 12 years. Anuria occurred in all patients 2.2 ± 1.4 days before death. Seven patients had disseminated intravascular coagulation. In all patients we observed (1) acute tubular lesions whose intensity correlated with blood lactate concentration; (2) intense infiltration by leukocytes, mainly monocytic, in glomeruli and interstitial capillaries as compared to controls; (3) presence of tubular cell apoptosis proved by the presence of apoptotic bodies (2.9% of tubular cells) significantly more frequently than in controls and confirmed by TUNEL and activated caspase-3 staining. Arteriolar/arterial thromboses were observed in only 4 of 19 patients, without any association with presence of disseminated intravascular coagulation.

Conclusions

Kidney lesions in septic shock go beyond those associated with simple acute tubular injury, notably capillary leukocytic infiltration and apoptosis. Vascular thrombosis, however, did not appear to play a major role in the majority of patients. The extent to which these lesions are specific to sepsis or are common to all multi-organ failure independent of its cause is yet to be elucidated.

Keywords

Kidney pathology Septic shock Critical care medicine Acute kidney injury Apoptosis Acute tubular necrosis 

Supplementary material

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Supplementary material 1 (DOC 96 kb)
134_2009_1723_MOESM2_ESM.ppt (1.5 mb)
Supplementary material 1 (PPT 1555 kb)
134_2009_1723_MOESM3_ESM.doc (50 kb)
Supplementary material 1 (DOC 50 kb)

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Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Nicolas Lerolle
    • 1
    • 2
    • 3
  • Dominique Nochy
    • 2
    • 4
  • Emmanuel Guérot
    • 2
    • 3
  • Patrick Bruneval
    • 2
    • 4
  • Jean-Yves Fagon
    • 2
    • 3
  • Jean-Luc Diehl
    • 2
    • 3
  • Gary Hill
    • 4
  1. 1.Département de Réanimation Médicale et de Médecine HyperbareCentre Hospitalo-Universitaire d’AngersAngers CedexFrance
  2. 2.Faculté de MédecineUniversité Paris DescartesParisFrance
  3. 3.Service de Réanimation MédicaleHôpital Européen Georges PompidouParis Cedex 15France
  4. 4.Laboratoire d’Anatomopathologie, Assistance Publique–Hôpitaux de ParisHôpital Européen Georges PompidouParisFrance

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