Malignant Nephrosclerosis

Shapiro, Phillip F.

doi:10.1001/archinte.1931.00150020030003

Cited by 22 publications

(2 citation statements)

References 17 publications

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“…3,34,44 The concept that glomerular lesions were ischemic was not supported by the India ink perfusion studies of autopsied kidneys performed by Shapiro; these studies found that ischemic glomeruli were particularly well perfused, thereby proving that obstructive arteriopathy could not be the cause of ischemic changes. 45 However, age-associated glomerular lesions are commonly called "ischemic," with a presumed arteriosclerotic association, 34 although the precise mechanism by which ischemia occurs is not well understood. To evaluate these concepts we scored 8570 glomeruli from 44 old kidneys and found that the presumptive ischemic-like glomeruli did not correlate with arteriosclerosis, as would have been expected if the lesions were caused by underlying arterial disease.…”

Section: Discussionmentioning

confidence: 99%

Glomerular Aging and Focal Global Glomerulosclerosis

Hodgin¹,

Bitzer²,

Wickman

et al. 2015

Journal of the American Society of Nephrology

181

242

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Kidney aging is associated with an increasing proportion of globally scarred glomeruli, decreasing renal function, and exponentially increasing ESRD prevalence. In model systems, podocyte depletion causes glomerulosclerosis, suggesting age-associated glomerulosclerosis could be caused by a similar mechanism. We measured podocyte number, size, density, and glomerular volume in 89 normal kidney samples from living and deceased kidney donors and normal poles of nephrectomies. Podocyte nuclear density decreased with age due to a combination of decreased podocyte number per glomerulus and increased glomerular volume. Compensatory podocyte cell hypertrophy prevented a change in the proportion of tuft volume occupied by podocytes. Young kidneys had high podocyte reserve (podocyte density .300 per 10 6 mm 3 ), but by 70-80 years of age, average podocyte nuclear density decreased to, ,100 per 10 6 mm 3 , with corresponding podocyte hypertrophy. In older age podocyte detachment rate (urine podocin mRNA-to-creatinine ratio) was higher than at younger ages and podocytes were stressed (increased urine podocin-to-nephrin mRNA ratio). Moreover, in older kidneys, proteinaceous material accumulated in the Bowman space of glomeruli with low podocyte density. In a subset of these glomeruli, mass podocyte detachment events occurred in association with podocytes becoming binucleate (mitotic podocyte catastrophe) and subsequent wrinkling of glomerular capillaries, tuft collapse, and periglomerular fibrosis. In kidneys of young patients with underlying glomerular diseases similar pathologic events were identified in association with focal global glomerulosclerosis. Podocyte density reduction with age may therefore directly lead to focal global glomerulosclerosis, and all progressive glomerular diseases can be considered superimposed accelerators of this underlying process.

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Section: Discussionmentioning

confidence: 99%

Glomerular Aging and Focal Global Glomerulosclerosis

Hodgin¹,

Bitzer²,

Wickman

et al. 2015

Journal of the American Society of Nephrology

181

242

View full text Add to dashboard Cite

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“…Although the incidence of hypertension is greater in females, the sequelae affect males more commonly. The male is more likely to have the malignant form of hypertension (69, 97–99). This finding is surprising in view of the frequency of chronic pyelonephritis in most series and the general assumption that pyelonephritis is more common in females (100).…”

Section: Hypertension and Hypertensive Cardiac Diseasementioning

confidence: 99%