BILATERAL RENAL CORTICAL NECROSIS AND THE GENERALIZED SHWARTZMAN REACTION. 1. REVIEW OF LITERATURE AND REPORT OF SEVEN CASES

A light- and electron-microscopic study of the so-called uni-visceral Shwartzman reaction

A morphological study was made on a particular model of Shwartzman reaction which was so designed as to occur mainly in the liver with minimal influence to the other parts of the body. The study was mainly focused on its mechanism; the role of the granulocytes, Kupffer cells, platelets and precipitated fibrin. It was revealed that Kupffer cells were severely damaged by the first, preparative injection and the most conspicuous finding after the second, provocative injection was marked granulocytic infiltration followed by massive hepatic cell necrosis. The infiltrating granulocytes sticked to the endothelium, degenerated Kupffer cells, or other granulocytes and, often aggregated around precipitated fibrin. The erythrocytes in the sinusoid also showed aggregation after the provocative injection of the endotoxin, which was, however, rather loose and easily washed out from the sinusoid by perfusion. It is suggested from the above observations that aggregation of granulocytes as well as precipitated fibrin plays an important role to disturb blood stream mechanically and leads to massive necrosis in the liver.

Renal cortical necrosis in a cat

An 8-year-old cat had symptoms of advanced renal failure. At postmortem examination it was found to have extensive bilateral renal cortical necrosis that appeared to have been in existence for some weeks. The literature on this type of lesion was reviewed, but no conclusions could be reached on the pathogenesis of this case.

Spontaneous bilateral renal cortical necrosis in animals

Six cases representing three species, previously diagnosed as bilateral renal cortical necrosis (BCN), were studied histologically. One horse had vascular lesions including fibrinoid necrosis and fibrinous thrombi in various organs. Intrarenally these lesions occurred in interlobular arteries, afferent arterioles, and glomeruli. Another horse had bilateral renal glomerular thrombosis but no extra-glomerular vascular lesion. Distinct fibrinous deposition in the renal vessels did not occur among the other four cases. A comparison is drawn between the characteristic lesions in the generalized Shwartzman reaction (GSR) and BCN as diagnosed in our autopsy material. The renal alterations were compatible with GSR in two horses only among the six cases.