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Acute renal failure — An integrative discussion of morphologic and functional findings

Das akute Nierenversagen — Eine integrative Diskussion morphologischer und funktioneller Befunde

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Summary

The ultrastructural alterations at the nephron established in animal experiments, were also confirmed, by means of an electron-microscopic examination, in eight cases of human acute renal failure (ARF). Special consideration was given in this study to single cell alterations, particularly in proximal tubular cells, with emphasis being placed on alterations due to single cell damage in the region of the renal fluid compartments. The ultrastructural alterations of the tubular cells in ARF, suggest serious impairment of the cellular capacity for electrolyte transport and metabolic processes. The shunt paths between the tubular fluid compartment and the functional interstitium, arising from necrosis of the tubular cells or dissolution of the gap or tight junctions, were discussed in terms of their significance for the directional, active transport processes of the tubular cells for sodium chloride and the passive water flow. The morphologic findings were reviewed in light of recent findings on cellular membrane processes and electrolyte transport. A reinterpretation of the morphologic and functional findings in ARF is suggested. This takes into consideration single cell function and the integrity of the renal fluid compartments.

Zusammenfassung

Durch elektronenmikroskopische Untersuchungen an 8 Fällen menschlicher akuter Nierenversagen konnten die aus tierexperimentellen Beobachtungen bekannten ultrastrukturellen Veränderungen am Nephron auch für das menschliche akute Nierenversagen bestätigt werden. Die Untersuchungen erfolgten unter besonderer Berücksichtigung der Einzelzellveränderungen, insbesondere der proximalen Tubuluszellen. Herausgestellt wurden die aus der Einzelzellschädigung resultierenden Veränderungen im Bereich der renalen Flüssigkeitskompartimente. Die ultrastrukturellen Veränderungen der Tubuluszellen beim akuten Nierenversagen deuten auf eine gravierende Beeinträchtigung der zellulären Transportkapazität für Elektrolyte und metabolischer Prozesse hin.

Die durch Tubuluszellnekrosen oder durch Lösung von Gap- bzw. Tight-Junctions entstehenden Shunt-Wege zwischen tubulärem Flüssigkeitskompartiment und funktionellem Interstitium werden in ihrer Bedeutung für die gerichteten aktiven Transportvorgänge der Tubuluszellen für Natriumchlorid und den passiven Wasserstrom diskutiert.

Die morphologischen Befunde werden unter besonderer Berücksichtigung neuer Ergebnisse der zellulären Membranprozesse und des Elektrolyttransportes besprochen. Eine Reinterpretation morphologischer und funktioneller Befunde beim akuten Nierenversagen unter besonderer Berücksichtigung der Einzelzellfunktion und der Integrität der renalen Flüssigkeitskompartimente wird vorgeschlagen.

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  1. Institute of Pathology, University of Tübingen, Germany

    H. v. Gise, T. Klingebiel & E. Mickeler

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Dedicated to Professor Dr. Adalbert Bohle in honor of his 60th birthday

This study was supported by the Deutsche Forschungsgemeinschaft (Gi 117/2-2 and Bo 216/22-2)

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v. Gise, H., Klingebiel, T. & Mickeler, E. Acute renal failure — An integrative discussion of morphologic and functional findings. Klin Wochenschr 60, 773–786 (1982). https://doi.org/10.1007/BF01721142

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