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Biomedical subjects

A Bohle

Publications and source records attributed to A Bohle.

At least 73 records · Page 4Linked to original sources
PubMed1987

Significance of tubulointerstitial changes in the renal cortex for the excretory function and concentration ability of the kidney: a morphometric contribution.

This is an editorial review of investigations into the correlation of structure and function of the kidney in various inflammatory and noninflammatory glomerular diseases and in focal and diffuse interstitial nephritis. In detail these investigations produced the following results: (1) The excretory function of the glomeruli for substances usually eliminated with the urine is, in the case of inflammatory and noninflammatory glomerular diseases, detrimentally affected by tubulointerstitial changes, i.e. by processes accompanied by interstitial fibrosis and tubular atrophy. Likewise primary interstitial renal diseases when accompanied by interstitial fibrosis and tubular atrophy may lead to reduction in GFR. (2) Inflammatory and noninflammatory glomerular diseases, even when very severe, are not accompanied by a measurable reduction in GFR when the renal cortex interstitium shows no changes and the tubules exhibit no pathological findings. (3) The concentration ability of the kidney, too, depends primarily on tubulointerstitial changes and not primarily on a reduction of the glomerular filtration surface area. As interstitial fibrosis and tubular atrophy increase, the maximum concentration ability of the kidney decreases, even when the glomerular structure is preserved. (4) The decrease in GFR in the case of processes in the renal cortex accompanied by severe interstitial fibrosis is the result of the reduction of the number and of the area of the postglomerular vessels, i.e. the result of an impeded outflow from the glomeruli and of a concomitant slower circulation through the glomeruli. (5) In the case of inflammatory and noninflammatory glomerular and extraglomerular renal diseases accompanied by slight interstitial fibrosis and tubular atrophy, the GFR is detrimentally affected via a hormonally controlled self-regulating mechanism (Thurau-mechanism) in the form as modified by Baumbach and Skott and Leyssac. The glomerular function thereby adapts to an insufficient tubular function, without there necessarily being any structural changes in the glomeruli.

Amyloidosis↗
PubMed1986

Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults.

The long-term clinical course of sporadic, acute endocapillary glomerulonephritis of poststreptococcal type is reported. In all cases, the diagnosis was established by renal biopsies and in most cases by clinical tests. The study is based on retrospective/prospective data from 36 children and 101 adults in the Federal Republic of Germany, Luxemburg, and Austria. In 72 patients (21 children, 51 adults) the disease course was clinically followed over periods of 2-13 years (clinical features: blood pressure, serum creatinine, proteinuria, hematuria). In this group, the number of clinical recoveries (i.e., all features within strictly defined normal ranges) increased with increasing length of observation. Children showed more rapid clinical recovery. 29% of the children and 41% of the adults showed no clinical recovery. Out of all 137 patients, 3 progressed to chronic renal failure, and 4 other patients died. Cases with an initial nephrotic syndrome had a significantly poorer long-term prognosis (p less than 0.005). Initial elevation of serum creatinine concentration due to acute renal failure did not influence the long-term prognosis. Our results indicate that the acute endocapillary glomerulonephritis of poststreptococcal type has a slow tendency towards clinical recovery under good hygienic conditions and if unaccompanied by nephrotic syndrome in the initial phase.

Adult↗
PubMed1986

[Importance of tubulo-interstitial changes in glomerular excretory and urine concentrating function of the kidney].

Results are presented for morphologic investigations on the correlation between structural and functional alterations in various inflammatory and non-inflammatory glomerular and extraglomerular renal diseases. The role of the glomeruli in the excretion of substances excreted exclusively by the urinary tract is dependent, to a degree not previously appreciated, on the condition of the postglomerular vasculature as well as on the functional status of the tubular epithelium. All processes which result in damage to the post-glomerular vasculature negatively influence glomerular excretory function by limiting the flow of blood out of the glomeruli and reducing glomerular perfusion. It is further assumed that all processes which negatively influence tubular reabsorption will also be detrimental to glomerular function as a result of increased pressure in the proximal renal tubule as well as via the Thurau mechanism. Finally it is suggested that the kidney's concentrating ability is partially dependent on tubular interstitial factors: with increasing width of the renal cortical interstitium and increasing atrophy of the renal tubule (as measured by the proximal tubules) the kidney's concentrating ability steadily diminishes.

Amyloidosis↗
PubMed1986

Decompensated benign nephrosclerosis and secondary malignant nephrosclerosis.

Using semiquantitative morphometric methods, the clinical picture of decompensated benign nephrosclerosis is distinguished from that of secondary malignant nephrosclerosis, designated as the consequence of high pressure. It is shown that hypertensive glomerulopathy triggered by high pressure and postglomerular interstitial fibrosis with tubular atrophy are in the foreground of pathologic changes in decompensated benign nephrosclerosis, whereas the preglomerular vessel network is most often affected in secondary malignant nephrosclerosis. The preglomerular vascular lesions in secondary malignant nephrosclerosis lead to such heavy stenosis of the afferent vessels that the clinical picture of hypertensive glomerulopathy is rarely observed, while that of ischemic glomerular capillary collapse is frequent. The preferred affliction of the glomeruli and the postglomerular vessel network leads in decompensated benign nephrosclerosis to severe interstitial fibrosis, which has a pyramidal form, decreasing from the base of the pyramid at the corticomedullary boundary to the outer renal cortex. In secondary malignant nephrosclerosis fibrosis of the renal cortical interstitium is homogeneous in all layers of the renal cortex. Clinically, decompensated benign nephrosclerosis and secondary malignant nephrosclerosis, which occur predominantly in young to middle-aged males, manifest malignant hypertension. They are also accompanied by progressive renal insufficiency.

Adult↗
PubMed1985

Morphologic contribution on gross hematuria in mild mesangioproliferative glomerulonephritis without crescents.

In order to clarify the pathogenesis of gross hematuria in mild forms of mesangioproliferative glomerulonephritis without crescents, systematic light microscopic, immunohistologic, electron microscopic, and some scanning electron microscopic investigations were carried out on 17 cases of this disease, in part on serial sections. The investigations produced the following results: In gross hematuria, erythrocytes pass into Bowman's space in the area of basement membrane ruptures. The basement membrane ruptures occur at sites where the basement membrane is infiltrated in its entire width by aggregated immune complexes. This occurs when these immune complexes are detached from the basement membrane by lysosomal digestion. As a working hypothesis, it is furthermore considered possible that in diseases accompanied by increased IgA production, circulating IgA is deposited at a higher rate in the glomerular filtration barrier and it is there degraded by an excessive reaction of local cells before morphologically identifiable immune complexes appear. In this process the basement membrane undergoes local destruction. It is also assumed that in gross hematuria, immune complexes other than IgA or hitherto unknown substances enter the basement membrane during the filtration process and trigger frustrane phagocytosis at the basement membrane by their presence, with consecutive basement membrane destruction. It is pointed out that gross hematuria occurs most often in mild forms of mesangioproliferative glomerulonephritis with IgA and C3 deposits in the mesangium and sometimes also in the capillary periphery. It could be shown that in mild forms of mesangioproliferative glomerulonephritis, hematuria occurs more often in the male sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Structure of the avian kidney.

The kidneys from 6 domestic fowl were fixed in situ by perfusion from the left ventricle. In the bird there are two types of nephrons. One reptilian-type without Henle's loop and medullary tissue, and one mammalian-type with Henle's loop lying in medullary tissue. Serial sections from kidney tissue embedded in plexiglass or in paraffin were used to study the architecture of eight reconstructed reptilian-type nephrons from different cortical levels. All reconstructed nephrons had four major bends, but particularly in the subcapsular nephrons additional bends parallel to the kidney surface were found. There was no loop of Henle, but before entering the collecting duct the distal tubule usually had a very thin-walled segment. No proximal convoluted part was found in the reptilian-type nephrons. The length of the tubules varied between 3,000 microns and 6,000 microns. In the distal tubule a macula densa segment was found in all nephrons of the reptilian and mammalian type. The capillary network between the inter- and intralobular veins was composed of increasingly larger capillaries towards the intralobular vein. Segments of the distal tubule were indented into these capillaries and completely surrounded by them. In the nephrons of the mammalian type the proximal tubule was found to be convoluted as is usual for mammalian species.

Animals↗
PubMed1985

Creatinine clearance and renal interstitium in diffuse endocapillary proliferative glomerulonephritis.

Morphometric investigations of the renal cortex on biopsies obtained from patients with diffuse proliferative endocapillary glomerulonephritis (EPGN) were compared to biopsies without pathological changes, both groups having a normal serum creatinine concentration at the time of biopsy. Our findings are as follows: In both groups a statistically significant correlation exists between the decrease of the endogenous creatinine clearance and the broadening of the interstitium. The mean endogenous creatinine clearance value in EPGN is 107.6 +/- 40.6 ml/min/1.73 qm, the mean endogenous creatinine clearance in normal kidneys is 108.2 +/- 28.5 ml/min/1.73 qm; the mean interstitial volume in EPGN is 14.5 +/- 2.9 vol.%, that in normal kidneys 9.5 +/- 2.9 vol.%, the difference is statistically significant. Comparing the run of the two curves (relationship between endogenous creatinine clearance and interstitial volume) of the investigated groups, one finds that they run a nearly parallel course, the curve of the EPGN being shifted statistically significant to the right. The mean values of number, single- and total area of the peri- and intertubular capillaries are identical in the cases of EPGN and in those biopsies without pathological findings. Furthermore no correlations could be established between the above mentioned measuring values and the endogenous creatinine clearance in the both investigated groups. Consequently in these cases with normal serum creatinine concentration the reduction of the glomerular filtration rate (gfr) accompanied by interstitial broadening cannot be explained by an impairment of the postglomerular blood flow. Perhaps a tubular functional disturbance, the cause or the consequence of the interstitial broadening impairs glomerular function by the tubular-glomerular feedback-mechanism and/or by an elevation of the intratubular hydrostatic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

On four cases of hemolytic-uremic syndrome without microangiopathy.

Four cases of hemolytic-uremic syndrome (HUS) are presented in which light and electron microscopic examination of renal biopsies (2 cases) and light microscopic examination of the kidneys on autopsy material (2 cases) revealed no changes reflecting microangiopathy. Based on these findings and on personal observation of 197 cases of HUS with glomerular or vascular changes, it is considered questionable whether the results of animal experiments by Brain et al. [1962] and Brian and Brain [1968] can be transferred to man. The cause of hemolytic anemia in HUS is considered unclarified, except for cases in which hemolysis is triggered by neuraminidase-producing bacteria and viruses.

Adolescent↗
PubMed1984

Association between rapidly progressive glomerulonephritis and the properdin factor BfF and different HLA-D region products.

Frequencies of the HLA antigens ABC, DR and MT, as well as of the properdin factor alleles were determined in 24 unrelated patients presenting with immune complex mediated idiopathic rapidly progressive glomerulonephritis (RPGN) type II. As in Goodpasture syndrome (RPGN type I with pulmonary hemorrhage), a significant association with the B-cell alloantigen HLA-DR 2 was demonstrated (relative risk for HLA-DR 2 positive individuals was 3.54; P less than 0.01). In addition a marked increase of the HLA specificity MT 3 was shown, which is supposed to belong to an antigen system of a second HLA-D region locus. The highest relative risk of 14.67 (P less than 0.00001), however, was calculated for all patients carrying the BfF phenotype. Increased numbers of patients positive for HLA-DR 2 and -MT 3, as well as BfF suggested immune response genes or disease-related mutations on different haplotypes responsible for a MHC (major histocompatibility complex) associated predisposition of RPGN type II.

Adolescent↗
PubMed1983

Clinical and morphological aspects of nephrotic syndrome in perimembranous, focally sclerosing and membrano-proliferative glomerulonephritis.

The following data was obtained by morphometric and photometric microscopic studies of renal biopsies from 140 patients with idiopathic perimembranous glomerulonephritis, 108 patients with focally sclerosing glomerulonephritis and 50 patients with membranoproliferative glomerulonephritis and correlation of the results obtained with available clinical data: 1. In all three diseases proteinuria and serum protein concentration show no tendency to stabilization in spite of increasing renal insufficiency. 2. With increasing renal insufficiency the proximal tubular cells become increasingly atrophic. 3. Protein resorption through the proximal tubulus cells becomes increasingly diminished with advancing renal insufficiency. It is concluded from the present data that proteinuria, which is primarily glomerular caused, is increased by increasingly diminished resorption of proteins in the tubulus system with increasing renal insufficiency. In this way, even under conditions of advanced renal insufficiency with reduced GFR, large amounts of proteins can be excreted and a nephrotic syndrome can persist to a stage of renal insufficiency.

Absorption↗
PubMed1983

Morphologic aspects of low-potassium and low-sodium nephropathy.

Renal biopsies from 40 patients with hypokalemia and hyponatremia of an average of 10 years' duration due to abuse of laxatives or diuretics, anorexia nervosa, or chronic vomiting were examined with morphometric methods. Light microscopy revealed the following alterations in the renal cortex as compared with 36 normal kidney: JGC were sometimes slightly and sometimes enormously enlarged (mean, 217%). Smaller glomeruli were found with reduction in the area of the glomerular capillaries and of Bowman's capsule (+/- 7%) but an increase in the area of the mesangial matrix by 25%. The proximal and distal tubules contained nonspecific vacuoles in only 8 of 40 biopsy specimens. Only minor, age-dependent arteriolosclerosis was demonstrable. In 75% of the cases, the interstitial surface area was increased (by 107%) with predominantly focal lymphocytic cellular infiltration. Interstitial fibrosis was more pronounced in emaciated patients. The morphologic-functional correlation between the increase of interstitial surface area and the rise in serum creatinine concentration was highly significant. Typical kaliopenic nephropathy is therefore detectable by light microscopy. GFR impairment correlates with the extent of interstitial fibrosis.

Adult↗
PubMed1983

Morphometric studies on acute renal failure in humans during the oligoanuric and polyuric phases.

Twelve biopsies from patients in the oligoanuric phase and 17 from patients in the polyuric phase of acute renal failure (ARF) were studied and compared morphometrically with 39 control biopsies. Measurements were taken on silvered semi-thin sections, which were classified according to each of three divisions of the renal cortex. All alterations observed were equally prominent in these three cortical zones. The number of peri- and intertubular capillaries was reduced in both phases of ARF (P less than 0.001), their mean surface area was increased (P less than 0.001), while their total surface area per visual field remained constant. The tubular epithelial tissue was distended in both ARF phases and the tubular lumina were simultaneously widened, as were Bowman's capsular spaces. The causes of these alterations are discussed. The findings are in accord with a concept of the pathogenesis of ARF, which ascribes a central role to damage of individual tubular cells.

Acute Kidney Injury↗