Summary
The clinico-pathological data from a patient with irreversible post-partum renal failure (IPRF) are presented. The electron microscopy of the late changes are described for the first time and consists of: 1. Thickening of the basement membrane. 2. Interposition of mesangial cells and matrix between the thickened basement membrane and the endothelial cell encircling the periphery of the tuft. 3. Multiplication of basal lamina material between mesangial cells and endothelial cells. 4. Proliferation of endothelial cells.
All of the above changes tend to obliterate the glomerular tufts and transform the vascular lumina into slit-like spaces. They explain morphologically why most patients with IPRF terminate in chronic renal failure, if they survive the early changes. The late occurring hypertension is regarded as a secondary stimulation of the renin-angiotension system caused by partial or complete occlusion of arteries and arterioles.
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Brain, M. C., Dacie, J. V., Hourihane, D. O-B.: Microangiopathic haemolytic anaemia: The possible role of vascular lesions in pathogenesis. Brit. J. Haemat. 8, 358–374 (1962)
Clarkson, A. R., Meadows, R., Lawrence, J. R.: Post-partum renal failure. The generalized Schwartzman reaction. Aust. Ann. Med. 18, 209–216 (1969)
Churg, J., Koffler, D., Paronetto, F., Rorat, E., Barnett, R. N.: Hemolytic uremic syndrome as a cause of postpartum renal failure. Amer. J. Obstet. Gynec. 108, 253–261 (1970)
Donadio, J. V., Jr., Holley, K. E.: Postpartum acute renal failure: Recovery after heparin therapy. Amer. J. Obstet. Gynec. 118, 510–516 (1974)
Eisinger, A. J.: The postpartum haemolytic uraemic syndrome. J. Obstet. Gynec. 79, 139–143 (1972)
Epstein, F. H., Scully, R. E.: Renal failure two months postpartum. New Engl. J. Med. 288, 93–99 (1973)
Finkelstein, F. O., Kashgarian, M., Hayslett, J. P.: Clinical spectrum of postpartum renal failure. Amer. J. Med. 57, 649–654 (1974)
Larcan, A., Rauber, G., Laprevote, M. C., Lambert, H., Andre, J. L.: Le syndrome uremohemolytique du post-partum. Nouv. Presse méd. 3, 1529–1534 (1974)
Lawrence, J. R., Meadows, R.: The relationship between postpartum renal failure and the hemolytic-uremic syndrome in glomerulonephritis. Morphology, natural history and treatment. Edit. by Kincaid-Smith, Mathew and Becker. New York-London-Syndey-Toronto: John Wiley and Sons 1973
Luke, R. G., Talbert, W., Siegel, R. R., Holland, N.: Heparin treatment for postpartum renal failure with microangiopathic haemolytic anaemia. Lancet 1970 II, 750–753
Ogg, C. S., Cameron, J. S.: Post-partum renal failure. Lancet 1969 I, 1317
Ponticelli, C., Imbasciatti, E., Tarantino, A., Graziani, G., Redaelli, B.: Post-partum renal failure with microangiopathic haemolytic anaemia. Nephron 9, 27–41 (1972)
Robson, J. S., Martin, A. M., Ruckley, V. A., MacDonald, M. K.: Irreversible postpartum renal failure. Quart. J. Med. 37, 423–435 (1968)
Rosenmann, E., Kanter, A., Bacani, R. A., Pirani, C. L., Pollak, V. E.: Fatal late postpartum intravascular coagulation with acute renal failure. Amer. J. med. Ass. 257, 259–273 (1969)
Scheer, R. L., Jones, D. B.: Malignant nephrosclerosis in women post partum. J. Amer. med. Ass. 201, 106–110 (1967)
Vasalli, P., Simon, G., Rouiller, C.: Electron microscopic study of glomerular lesions resulting from intravascular fibrin formation. Amer. J. Path. 43, 579–617 (1963)
Wagoner, R. D., Holley, K. E., Johnson, W. J.: Accelerated nephrosclerosis and postpartum acute renal failure in normotensive patients. Ann. intern. Med. 69, 237–248 (1968)
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Becher Carstens, P.H., Karalakulasingam, R. Late changes of irreversible post-partum renal failure. Virchows Arch. A Path. Anat. and Histol. 367, 171–179 (1975). https://doi.org/10.1007/BF00430705
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DOI: https://doi.org/10.1007/BF00430705