実験的動脈硬化性萎縮腎の研究と腎生検の臨床

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In 1931,' Prof. M. Masugi and Dr. Y. Tomizuka succeeded in experimentally producing glomerulonephritis. Their success is looked upon as an epochal achievement in the annals of pathology. Over the following 35 years, clinical and pathological research in renal diseases has been pressed forward with a great many eminent results. Recent workers have the benefit of a wide array of new techniques such as biopsy and electron microscopy. However, in animal experiments on Bright's diseases, nephrosis and arteriosclerotic nephrosclerosis still ended in failure, glomerulonephritis being an exception. In experiments conducted over a few years, pathologic changes closely resembling human arteriosclerotic nephrosclerosis were generated in rabbits fed on lanolin and cotton seed oil. Recently, the use of biopsy for renal diseases is more frequently employed and contributes greatly to diagnosis and the determination of prognosis, as well as investigations in the correlation of clinical signs and pathological findings. Biopsy techniques being relatively simple and safe, they will probably be increasingly utilized in the future. The present authors wish to present their views and interpretations in the principle renal diseases as approached through biopsy along with the results of the experimentally induced arteriosclerotic nephrosclerosis. 1. Experimental Studies on Arteriosclerotic Nephrosclerosis Experimental rabbits were fed on a mixture of lanolin, cotton seed oil, and soy bean residua for 100 days, the controls receiving only the bean residua. Serum cholesterol and body weight were higher in the experimental group than the controls, though no difference was detected in blood cell counts and hemoglobin percentage. At autopsy, the experimental group kidneys were smaller, weighing 12.5 g. on an average. The surfaces were fine granular and microscopically, thickening of the arteriolar wall, swelling or losing of endothelial cells, and precipitation of PAS positive substances were found. Such histological findings as atrophy or hyaline degeneration of the glomeruli, thickening of tubule walls, and the formation of many hyaline casts were present. Sclerosis of the small arteries in the kidney was moderate. At the cardial origin of the aorta, no atheromatosis but in myocardial medium and small arteries moderate sclerosis was found. Small arteries of the lung had significant thickening and no sclerosis appeared in the basal arteries of the brain. 2. Clinical Studies on Renal Biopsy Acute glomerulonephritis : Histological recovery, as observed through biopsy, is in general later than the recovery of renal functional tests. In those cases which progressed to a chronic stage, some destroyed glomeruli were still found in spite of almost completely normalized renal function tests. Chronic nephritis : All grades, from slight to severe, were found by biopsy. The tendency of compensation for renal function is so great that although histological changes were advanced and had already degraded to nephrosclerosis, some slight degree of function was still retained. Chronic pyelonephritis : Histological findings caused not only by bacterial infection from the renal pelvis but also by a local allergic reaction as reported by Dr. Fujimoto were encountered. Nephrotic syndrome : The nephrosis may be related to a variety of renal diseases, including glomerulonephritis, collagen diseases (disseminated lupus erythematosus, periarterit'is nodosa, etc.), amyloid diseases, thrombosis of the renal vein, chronic pyelonephritis, diabetic nephropathy, and syphilis. It was possible to differentiate these diseases through biopsy. Kimmelstiel-Wilson's syndrome : In those cases with albuminuria, diabetic retinopathy, and hypertension, the "nodular lesion" was usually found. Dr. Miwa recognized the usefulness of this fact in the diagnosis of Kimmelstiel-Wilson's syndrome. Essential hypertension : Function tests by themselves are not sufficient in the differentiation of essential hypertension and glomerulonephritis or pyelonephritis. Biopsy was useful in this respect.
千葉大学の論文
1966-09-28

実験的動脈硬化性萎縮腎の研究と腎生検の臨床

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