Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher.

  • Jardine, Robert.
Date:
[1911?]
Catalogue details

Licence: In copyright

Credit: Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    the other side slightly. An incision of about half an inch in length and one- third of an inch in depth was made into the kidney substance. There was little bleeding, and the appearance of the kidney was so strange that nothing more was done. After the operation, patient became restless and complained of abdominal pain, but there were no convulsions. She died ten hours after the operation and about five and a half days from the commencement of the suppression of urine. The post-mortem examination was made by Dr. Carstairs Douglas. There was some general oedema, and also slight ascites. The liver was of moderate size, pale and fatty. The intestine was normal. The heart was of moderate size, and fatty. The valves were healthy, and there were some ante-mortem •clots in the right side. The lungs were congested and oedematous, and showed ■emphysema of the anterior borders. The kidneys and a portion of the liver were placed in formalin and sent to Dr. Teacher for examination. The kidneys were somewhat larger than normal. The capsule of the right kidney had been stripped off at the operation but replaced, and lay separated from the cortex by a layer of blood clot. The capsule of the other kidney was slightly thickened, but stripped readily. It was congested, and there were numerous small haemorrhages between it and the surface of the kidney. On section the kidneys (Plate XX. Fig. 1) presented an extremely striking appearance. They were congested, but the degree of contrast between the inner zone of the cortex and the medulla and their appearance were not far removed from normal. The remainder of the cortex, however, over practically the whole surface of the organ and in between the pyramids, was the seat of very profound changes, apparently of the nature of infarction. At all points there appeared to be a layer of normal cortex next the medulla, and in places there was some normal-looking tissue on the surface. The infarcted tissue presented the usual dull, opaque, yellow appearance with congested and hsemorrhagic margins. The pelves and ureters were normal. The walls of the larger blood vessels appeared to be slightly thickened, but there was no thrombosis or endarteritis visible to the naked eye. The blood vessels lying between the cortex and medulla were fairly prominent, and they also could be seen to be free from thrombosis. Microscopic Examination.—Sections were prepared from portions of both kidneys, and mounted in series of some length with a view to following the small blood vessels which were seen to be occupied by thrombi. In the infarcted area all the structures were in a state of necrosis which was almost complete, nuclear staining as a rule having disappeared, although the out- lines of the tubules and glomeruli were still quite distinct. The extent of the necrosis was even greater than seemed to be the case from the gross appearance of the organ, and it involved fully two-thirds of the entire cortex; but showed considerable irregularity. At most points there was a narrow zone close to the medulla which was not necrotic, and in places the living tissue extended almost to the surface. A very small amount of living cortex was also found scattered along the surface of the kidney. The capsule was slightly thickened but fibrous in character, and showed no sign of active inflammatory •change. There was no difference between the two kidneys, the decapsulation having apparently produced no changes. The kidney had not been perfectly normal, as there was a slight excess of interstitial connective tissue generally, and in certain areas there was a con- siderable amount of rather cellular tissue and swelling and catarrh and irregular dilatation of the tubules. Apparently there had been a slight subacute interstitial nephritis. In places there was considerable catarrh of the tubules with necrosis and shedding of the epithelium in the surviving
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