Akikusa B, Kondo Y, Irabu N, Shigematsu H
Acta Pathol Jpn. 1983 Mar;33(2):323-31.
Renal vascular changes in severe hypertension were studied. Twenty-five cases selected from 4,629 autopsies were classified into 2 groups according to the cause of death: group 1 (9 cases died of renal failure) and group 2 (16 cases of extra-renal death). Group 1 had been clinically diagnosed as malignant hypertension and had the hallmarks of malignant nephrosclerosis characterized by arteriolar fibrinoid necrosis and edematous intimal thickening. Group 2 had been clinically diagnosed as benign hypertension and basically exhibited the changes of benign nephrosclerosis. However, about half of the cases of group 2 had arteriolar fibrinoid necrosis, though the lesion was usually less extensive than in group 1. Immunofluorescence revealed similar deposits of immunoglobulins and fibrinogen in the site of fibrinoid necrosis observed in both groups. As for the changes of interlobular arteries, a quantitative analysis disclosed a distinctive difference between groups 1 and 2 with respect to the narrowing ratio of arterial lumina, though edematous intimal thickening was recognized on relatively rare occasions in the distal interlobular arteries in a few cases of group 2. From the results, the problem of transition from the benign to malignant nephrosclerosis was discussed.
对重度高血压患者的肾血管变化进行了研究。从4629例尸检中选取25例，根据死因分为两组：第1组（9例死于肾衰竭）和第2组（16例死于肾外原因）。第1组临床诊断为恶性高血压，具有恶性肾硬化的特征，表现为小动脉纤维蛋白样坏死和内膜水肿性增厚。第2组临床诊断为良性高血压，基本表现为良性肾硬化的变化。然而，第2组约半数病例存在小动脉纤维蛋白样坏死，尽管病变通常不如第1组广泛。免疫荧光显示两组在纤维蛋白样坏死部位均有相似的免疫球蛋白和纤维蛋白原沉积。关于小叶间动脉的变化，定量分析显示第1组和第2组在动脉管腔狭窄率方面存在显著差异，尽管在第2组少数病例的小叶间动脉远端相对少见内膜水肿性增厚。根据这些结果，对从良性肾硬化向恶性肾硬化转变的问题进行了讨论。
