On the Pathology of the Morbid State Commonly Called Chronic Bright's Disease with Contracted Kidney. (“Arterio-Capillary Fibrosis.”)

Abstract

DR. B}RIGHT and subsequent pathologists have fully recognised that the granular contracted kidney is usually associated with morbid changes in other organs of the body. The disease in the kidney and the coexistent morbid changes are commonly grouped together and collectively termed "chronic Bright's disease." In this communication we propose to consider the pathology of this morbid condition. We are induced to do this because our observations tend to show that the present prevailing pathological theories do not fully comprehend the whole history of the disease. It is, we believe, generally assumed that the kidney is the organ primarily affected, and in consequence a cachexia is induced through which other organs subsequently suiffer an d VOL. LV.

The role of renal microvascular disease and interstitial inflammation in salt-sensitive hypertension

“…16 The controversy initially centered on the association of hypertension and vascular disease with 'chronic' Bright's disease, [17][18][19] but it was soon recognized that hypertension could be present without renal parenchymal damage. An important autopsy study, published in the 1930s, reported that arteriolar disease ('arteriolosclerosis') was much more likely to be present in the kidneys of hypertensive subjects than in other organs such as the spleen.…”

Subtle Renal Injury Is Likely a Common Mechanism for Salt-Sensitive Essential Hypertension

“…31 Despite minimal evidence for clinical renal disease, it has been known for Ͼ150 years that patients with hypertension almost always have microvascular disease (originally termed arteriocapillary fibrosis and now called arteriolosclerosis) in the systemic and renal vasculature. 32 In one study, 98% of kidneys from hypertensive individuals had renal microvascular disease and mild to moderate tubulointerstitial injury. 33 Another group reported that it is only when the microvascular disease is in the kidney that there is a correlation with the presence of hypertension.…”

Inference of the Existence of High Blood Pressure as a Cause of Renal Disease in the Mid-19th Century: Observations on Vascular Structures in the Kidney

“…Gull and Sutton [11] further showed that the same fibroid and hyaline-fibroid formation is seen in meningeal arteries. 'Our examinations have shown us that this hyaline-fibroid formation commences, as regards the pia 2.…”

“…In 1872 William Gull published a landmark paper coauthored with his colleague, Henry Sutton of the London Hospital, entitled 'On the Pathology of the Morbid State Commonly Called Chronic Bright's 'Disease with Contracted Kidney' [11]. Born on 31 December 1816, he graduated from Guy's Hospital in 1841.…”

“…In the paper of 1872 [11], Gull and Sutton appended a subtitle in parentheses (Arterio-Capillary Fibrosis), indicating their fundamental disagreement with Johnson who, they claimed, was describing a post-mortem artifact or 'congestion', seen '... in by far the majority of post-mortem examinations ... It appears to us, therefore, that Dr Johnson had attached undue importance to these slight changes in the epithelial tissue' [p. 329].…”