Bhagavan B S, Wenk R E, Dutta D
Hum Pathol. 1979 Nov;10(6):669-83. doi: 10.1016/s0046-8177(79)80111-2.
The exact pathways of urinary reflux into the renal veins were studied in four cases of clinical obstructive uropathy and in 50 normal human cadaver kidneys. In the four clinical cases Tamm-Horsfall uromucoprotein was used as a marker for location of urine. Routine light microscopy and indirect immunofluorescence for Tamm-Horsfall uromucoprotein using rabbit antiserum showed tubular backflow up to the glomerulus. Dilated tubules filled with Tamm-Horsfall uromucoprotein ruptured into thin walled veins, forming tubulovenous anastomoses with extrusion of their contents into veins. The uromucoprotein was present in interlobar and arcuate veins with superimposed thrombosis and thrombophlebitis. Injection studies using pigmented gelatin in 45 normal cadaver kidneys and pigmented vinylite with corrosion casts in five additional kidneys complemented the clinical studies. Two types of urovascular communication were produced: the less frequent direct pyelovenous communication between a rupturing fornix and an adjacent small vein, and the more common indirect pyelovenous communication in which a ruptured fornix produced a sinus extravasate, which extended along the perivenous spaces of interlobar and arcuate veins. This extravasate gained access into the veins at points of rupture where venous tributaries joined the major veins in the renal medulla. The clinical implications of these tubulovenous and pyelovenous pathways of urinary reflux include backflow of whole urine and continued nephronic function in obstructive uropathy, "reverse backflow" of blood and hematuria, and a direct access for infectious agents into the circulation. These channels provide anatomic correlates for radiologic findings of extravasates and some backflow patterns of contrast material in pyelograms of clinical obstructive uropathy. The possible immunologic consequences of refluxing Tamm-Horsfall uromucoprotein gaining access to tissues and circulation are speculative.
在4例临床梗阻性尿路病患者及50个正常人体尸体肾脏中，研究了尿液反流至肾静脉的确切途径。在这4例临床病例中，使用Tamm-Horsfall尿粘蛋白作为尿液定位的标志物。采用兔抗血清对Tamm-Horsfall尿粘蛋白进行常规光学显微镜检查和间接免疫荧光检查，结果显示肾小管反流直至肾小球。充满Tamm-Horsfall尿粘蛋白的扩张肾小管破裂进入薄壁静脉，形成肾小管-静脉吻合，其内容物被挤压入静脉。尿粘蛋白存在于叶间静脉和弓状静脉中，并伴有血栓形成和血栓性静脉炎。在45个正常尸体肾脏中使用色素明胶进行注射研究，并在另外5个肾脏中使用色素乙烯基塑料和铸型腐蚀技术进行补充研究，这些研究对临床研究起到了辅助作用。产生了两种类型的尿路-血管交通：一种是较少见的破裂穹窿与相邻小静脉之间的直接肾盂-静脉交通；另一种是较常见的间接肾盂-静脉交通，即破裂穹窿产生窦外渗，沿叶间静脉和弓状静脉的静脉周围间隙扩展。这种外渗在肾髓质中静脉分支与主要静脉汇合处的破裂点进入静脉。这些尿液反流的肾小管-静脉和肾盂-静脉途径的临床意义包括：在梗阻性尿路病中全尿反流和持续的肾单位功能、血液“反向反流”和血尿，以及病原体直接进入循环。这些通道为临床梗阻性尿路病肾盂造影中造影剂外渗和一些反流模式的放射学表现提供了解剖学依据。反流的Tamm-Horsfall尿粘蛋白进入组织和循环可能产生的免疫后果尚属推测。
