fibrin and Kidney-Tubular-Necrosis--Acute

We investigate the morphological characteristics that may differentiate between ischemic acute tubular necrosis (ATN) and autolysis in postmortem samples. Renal tissue from 57 postmortem cases with an antemortem diagnosis of ATN and 57 age-/sex-matched control cases were examined for 10 morphological characteristics: epithelial proliferation (Ki-67 immunoperoxidase positivity), fibrin thrombi, tubular epithelial whorls, mitoses, casts, autolysis, tubulorrhexis, epithelial flattening, interstitial inflammation, and interstitial expansion. Tubular epithelial whorls were found in 16 ATN cases and were absent in controls. These findings suggest that specific morphological criteria may distinguish ischemic ATN from autolysis. Diagnoses of ATN may be confirmed using these combined criteria as contributing to cause of death and/or to ascertain previously undiagnosed cases of ATN postmortem.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Cell Proliferation; Diagnosis, Differential; Epithelial Cells; Female; Fibrin; Forensic Pathology; Humans; Immunoenzyme Techniques; Ki-67 Antigen; Kidney Glomerulus; Kidney Tubular Necrosis, Acute; Kidney Tubules; Male; Microscopy; Middle Aged; Postmortem Changes; Sensitivity and Specificity; Staining and Labeling; Thrombosis; Young Adult

In previous studies we have presented morphological evidence that the terminal shock-like phase of fatal meningococcemia is caused by the occlusion of the pulmonary microcirculation with thrombi composed of platelets, leukocytes, and fibrin. We have also shown that in experimental meningococcemia, pretreatment of rabbits with heparin sodium prevents fibrin formation but does not influence the cellular pulmonary thrombi and does not prolong survival. If our theory is correct, drugs that inhibit platelet aggregation and leukocyte adhesion in rabbits should prolong life. The present experiment demonstrates that pretreatment with a small dose of aspirin doubles the survival time without altering the mortality.

Topics: Animals; Aspirin; Female; Fibrin; Kidney Glomerulus; Kidney Tubular Necrosis, Acute; Lung; Meningococcal Infections; Rabbits; Sepsis; Shock, Septic

Topics: Adult; Arteries; Biopsy; Child; Disseminated Intravascular Coagulation; Female; Fibrin; Graft Rejection; Humans; Hypertension, Malignant; Kidney; Kidney Diseases; Kidney Glomerulus; Kidney Tubular Necrosis, Acute; Pre-Eclampsia; Pregnancy; Scleroderma, Systemic; Transplantation, Homologous; Vascular Diseases

Topics: Abruptio Placentae; Female; Fibrin; Kidney Tubular Necrosis, Acute; Nephrons; Placenta; Pregnancy