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Mann, 56 J., renale Hypertonie (stimulierte Reninsekretion durch Zellen
des juxtaglomerulären Apparates infolge Minderdurchblutung).
Nephrektomie
- In einem Teil des Präparates: Weite Tubuluslumina mit weit
auseinanderstehenden Glomerula mit offenen Kapillarschlingen
- Im anderen Teil Oberfläche der
Niere eingesunken (eingesunkene Oberflaeche)
- Dichtstehende Glomerula
- Glomerulumschlingen eng
- Lumen der Tubuli entweder eng oder inexistent, solide Epithelstränge,
Zellen atrophisch
- Interstitium verbreitert, wenig Fibrose, praktisch keine Entzündung
Nomenklatur:
Subinfarkt bedeutet Atrophie des Nierenparenchyms infolge einer Minderdurchblutung:
Hypoxämie, die nicht zum vollständigen Infarkt ausreicht.
Subinfarkt bedeutet demnach nicht Infarkt, der annähernd die
ganze Niere betrifft: Dies wird als ausgedehnter (oder "subtotaler")
Niereninfarkt bezeichnet
Pathogenese:
Minderdurchblutung der ganzen Niere oder eines Segmentes der Niere
infolge arterieller Stenose (z.B. arteriosklerotische Plaque am Abgang
der Nierenarterie von der Aorta)
56-year-old male suffered from renovascular hypertension; nephrectomy was performed.
- A section of the kidney is shown. In the lower part of the slide, the cortex shows a regular architecture; individual glomeruli are set apart
by a vast number of tubules exhibiting distinct lumens.
- In the upper part of the slide, the surface of the kidney is conspicuously depressed (eingesunkene Oberfläche).
In this region, glomeruli are crowded due to pronounced
tubular atrophy. The tubules are small and often have inapparent lumens, thus forming in part solid sheets of epithelium. This pattern is typical
of chronic ischemic atrophy. It is also referred to as ‘endocrinization’ of tubules, because of the resemblance of atrophic tubules to
the acinar tissue of endocrine glands.
- A modest interstitial infiltrate of mononuclear cells is present, however, fibrosis is absent.
Nomenclature: Chronic ischemic atrophy has also been referred to as subinfarction. Hypoxemia is severe
enough to cause atrophy in subinfarction.
Pathogenesis: Ischemia of the entire kidney or a segment of the kidney due to stenosis of the main renal artery. This is most commonly caused by
atherosclerotic occlusion. Fibromuscular dysplasia (renal artery stenosis in children and young adults), vasculitis (e.g.Takayasu’s arteritis),
retroperitoneal fibrosis, neurofibromatosis and compression of the artery by a neoplasm are observed infrequently. Consequence of renal artery stenosis
is a decrease in renal arteriolar pressure leading to an increased secretion of renin by juxtaglomerular cells and in turn production of the
vasoconstrictor angiotensin II.