Helmchen U
Abt. Pathologie I, Universität Göttingen.
Z Kardiol. 1987;76 Suppl 4:99-105.
The morphological consequences of acute or chronic renal ischemia may consist of an anemic kidney infarction, bilateral cortical necrosis, acute tubular lesions in circulatory renal failure, so-called subinfarction, as well as arteriosclerotic endstage kidney. In renal biopsies obtained from patients with acute renal failure, renal dysfunction can be morphologically explained by acute intra- and extracapillary necrotizing glomerulonephritis in 50% of cases, and by solely acute tubular lesions in 30% of cases. It is suggested that the development of acute tubular lesions during circulatory insufficiency might be favoured by an angiotensin II-dependent vas efferens constriction, leading to a reduction of peritubular blood flow in the presence of preserved glomerular filtration. The balance between demand and supply of oxygen within the tubular epithelial cells might thereby be critically disturbed.
急性或慢性肾缺血的形态学后果可能包括贫血性肾梗死、双侧皮质坏死、循环性肾衰竭中的急性肾小管病变、所谓的亚梗死，以及动脉硬化终末期肾病。在急性肾衰竭患者的肾活检中，50%的病例中肾功能障碍可从形态学上解释为急性毛细血管内和毛细血管外坏死性肾小球肾炎，30%的病例中仅为急性肾小管病变。有人认为，循环功能不全期间急性肾小管病变的发展可能受血管紧张素II依赖性出球小动脉收缩的促进，导致在肾小球滤过功能正常的情况下肾小管周围血流减少。由此，肾小管上皮细胞内的氧供需平衡可能会受到严重干扰。
