Richman A V, Okulski E G, Balis J U
Ann Clin Lab Sci. 1981 May-Jun;11(3):211-9.
The kidneys of rhesus monkeys, infused either with a single bolus of endotoxin(10 mg per KG) or continuously at the rate of 10 mg per kg per hour for periods of up to 22 hours, have been examined by light and electron microscopy. Monkeys infused continuously with Ringer's lactate were used as controls. Only minor morphologic changes were observed in those animals receiving a bolus of endotoxin. In the animals continuously infused, sequestration of neutrophils and monocytes was observed in the peritubular capillaries and, to a lesser extent, in the glomeruli. These changes were associated with phagocytosis of endotoxin, occasional fibrinous deposits, and extensive endothelial damage with focal capillary disruption. In the advanced stages, interstitial edema and early necrosis of tubular epithelium were observed. Our data indicate that endothelial damage and associated events relating to the sequestration of phagocytic leukocytes involve the peritubular capillaries primarily and that this process plays a role in the genesis of acute tubular necrosis associated with endotoxemia. In preliminary studies involving the study of kidneys from patients dying with documented Gram negative sepsis and acute renal failure, sequestered nucleated cells have been observed in the peritubular capillaries of the renal cortex and upper medulla. This suggests that similar patterns of endotoxin mediated vascular injury may be occurring in human sepsis.
通过光学显微镜和电子显微镜对恒河猴的肾脏进行了检查，这些恒河猴分别接受了单次大剂量内毒素注射（每千克10毫克），或连续22小时以每千克每小时10毫克的速率输注内毒素。以连续输注乳酸林格液的恒河猴作为对照。接受大剂量内毒素注射的动物仅观察到轻微的形态学变化。在连续输注的动物中，观察到中性粒细胞和单核细胞在肾小管周围毛细血管中聚集，在肾小球中聚集程度较轻。这些变化与内毒素的吞噬作用、偶尔的纤维蛋白沉积以及广泛的内皮损伤和局灶性毛细血管破裂有关。在晚期，观察到间质水肿和肾小管上皮早期坏死。我们的数据表明，内皮损伤以及与吞噬性白细胞聚集相关的事件主要累及肾小管周围毛细血管，并且这一过程在与内毒素血症相关的急性肾小管坏死的发生中起作用。在涉及对死于确诊革兰氏阴性败血症和急性肾衰竭患者的肾脏进行研究的初步研究中，在肾皮质和上髓质的肾小管周围毛细血管中观察到了聚集的有核细胞。这表明在人类败血症中可能发生类似的内毒素介导的血管损伤模式。
