Jones D B
Lab Invest. 1982 Mar;46(3):254-64.
The author studied with light microscopy, scanning electron microscopy, and transmission electron microscopy 19 kidney biopsies from patients with oliguric and nonoliguric acute renal failure, two biopsies from patients with renal failure due to bilateral ureteral obstruction, and 15 biopsies with near normal tubules. In acute renal failure, there were no intrinsic lesions of glomeruli, but lesions of varying severity were found in the proximal and distal tubules. Proximal tubular changes included diminished, bizarre or absent brush border, often with no or multiple cilia (often more severe in the straight segment of the proximal tubule); luminal surface blebs or bizarre projections; decreased, flattened, or absent basal-lateral interdigitations simplified cuboidal appearance; bizarre lateral interdigitations; enlarged "contracted" attachment bodies; increased cytosomes, "osmotic" or autophagic; and decreased apical vacuoles. Distal tubule changes included decreased basal-lateral interdigitations of the convoluted segment, some decrease in microvilli, increased cytosomes and luminal casts, and enlarged "contracted" attachment bodies. These changes imply severe diminution of luminal and antiluminal surface area which may decrease sodium and chloride flux and, thus, might induce renal cortical vasoconstriction by tubuloglomerular feedback mechanisms. Tubular changes resulting from partial ureteral obstruction closely resembled those of acute renal failure.
作者运用光学显微镜、扫描电子显微镜和透射电子显微镜，研究了19例少尿型和非少尿型急性肾衰竭患者的肾活检组织、2例双侧输尿管梗阻所致肾衰竭患者的活检组织以及15例肾小管近乎正常的活检组织。在急性肾衰竭中，肾小球无内在病变，但近端和远端肾小管存在不同程度的病变。近端肾小管的变化包括刷状缘减少、形态怪异或缺失，常无纤毛或有多个纤毛（常在近端小管直段更严重）；管腔表面有泡状或怪异的突起；基底外侧指状突减少、变平或缺失，细胞呈简单立方状外观；外侧指状突怪异；“收缩”附着体增大；胞质体增多，呈“渗透”或自噬状态；顶端空泡减少。远端肾小管的变化包括曲段基底外侧指状突减少，微绒毛略有减少，胞质体增多，管腔内有管型，“收缩”附着体增大。这些变化意味着管腔和反腔表面积严重减小，这可能会减少钠和氯的通量，从而可能通过肾小管-肾小球反馈机制诱发肾皮质血管收缩。部分输尿管梗阻导致的肾小管变化与急性肾衰竭的变化极为相似。
