The pathology of end-stage renal disease in hemodialysis patients.

The pattern of the renal disease and the pathological changes were studied in the kidneys of 80 autopsied patients who were maintained on hemodialysis for periods of up to seven years. Chronic pyelonephritis was most frequently encountered (25%); next in frequency were chronic glomerulonephritis (17.5%) and nephrosclerosis (17.5%). Moderate to severe intrarenal vascular changes were seen; intimal changes were most prominent. Statistically significant differences were observed in the distribution of the initimal lesions in intrarenal vessels of different calibres. Deposits of oxalate crystals, usually in the renal tubules, were encountered in all kidneys except four. Twenty-four patients (30%) showed acquired cystic kidney disease; renal calcification was observed in 61 others. The pathogenesis of these lesions in hemodialysis kidneys and their clinical significance are discussed.