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The kidneys
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Diabetic nephropathy may also include hyaline arteriolosclerosis, and increased susceptibility to pyelonephritis and papillary necrosis. Diabetic nephropathy is a progressive disease, the rate of progression being influenced by coexisting hypertension, the activity of the local renin–angiotensin system, and the degree of hyperglycaemia. Recent studies have confirmed that the inhibition of angiotensin generation by angiotensin-converting enzyme inhibitors or angiotensin receptor blockade has a beneficial effect on the progression of diabetic renal disease superior to that of other antihypertensive agents. Once diabetic nephropathy is established, progression is less influenced by strict diabetic control.
Atherosclerosis and the Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
There does not exist one definite microcirculatory manifestation of atherosclerosis. Rather, there is an array of different microcirculatory involvements in distinct processes with relevance to atherosclerosis. For instance, the microcirculation shows functional alterations during atherosclerotic progression in larger feeding arteries that are not necessarily associated with morphological changes of the microcirculatory unit per se (downstream dysfunction). Beside diabetes and hypertension (resulting in various microvascular changes including hyaline arteriolosclerosis), the microcirculation may be affected by systemic pathophysiological challenges such as immunologic factors during acute and/or chronic rejection of transplanted organs (transplant-associated accelerated allograft atherosclerosis, AAA) as well as effects of drugs and surgical interventions (iatrogenic microvascular damage). Finally, one paragraph will cover the microcirculation as it becomes relevant in vaso vasorum of complicated atherosclerotic lesions from larger vessels.
Nutritional Strategies for the Patient with Diabetic Nephropathy
Published in Jeffrey I. Mechanick, Elise M. Brett, Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
The classic histopathological lesion, first described by Kimmelsteil and Wilson in 1936 [7], is characterized by nodular mesangial sclerosis, thickened glomerular basement membranes, thickened tubular basement membranes, tubular atrophy, and interstitial fibrosis. Vascular morphologic changes include microaneurysms and hyaline arteriolosclerosis of both afferent and efferent arterioles. Renal biopsies in 30% of patients with T2DM and macroalbuminuria reveal other etiologies for kidney disease, while in patients with T1DM, there is nearly always classic diabetic nephropathy [8]. Important and potentially reversible diagnostic considerations are renal ischemia, secondary to renal artery stenosis, and drug-induced acute renal failure. Other etiologies for renal disease should be considered if there is active urinary sediment, less than 5-year duration of diabetes, absent diabetic retinopathy, or acute renal failure.
Pathological diagnosis of Coronavirus-related nephropathy: insight from postmortem studies
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Francesca Sanguedolce, Magda Zanelli, Elisabetta Froio, Alessandra Bisagni, Maurizio Zizzo, Stefano Ascani, Giovanni Stallone, Stefano Netti, Elena Ranieri, Ugo Falagario, Giuseppe Carrieri, Luigi Cormio
Renal pathology of MERS patients has been assessed in a few single-case studies. As for SARS-CoV, kidneys showed mostly degenerative and regenerative tubular changes, namely acute tubular sclerosis, ectatic renal tubules, unevenly distributed and hyperchromatic tubular epithelial cells nuclei, necrosis, sloughing and loss of brush surface of the proximal tubular epithelial cells and mitotic activity, as well as intratubular proteinaceous and granular casts [86,93,94]; in two cases, a diagnosis of acute tubular necrosis was rendered [86,93]. Examination of the renal parenchyma from the first autopsy of a MERS patient showed 5–10% globally sclerotic glomeruli, thickening of Bowman’s capsule, severe atherosclerosis, and hyaline arteriolosclerosis [94]. Chronic or acute interstitial inflammation, in the form of acute tubulointerstitial nephritis, were minor findings overall [93,94]. Interestingly, other authors reported no acute renal changes at all [84,95], even in presence of AKI, thus hypothesizing an indirect mechanism of renal injury due to hypotension rather than direct viral infection [95].
Intrarenal resistive index conundrum: systemic atherosclerosis versus renal arteriolosclerosis
Published in Renal Failure, 2019
Gabriel Ștefan, Cosmin Florescu, Alexandru-Anton Sabo, Simona Stancu, Gabriel Mircescu
Hyaline arteriolosclerosis is a common vascular lesion, found in many different situations, including aging, arterial hypertension, diabetes mellitus, focal and segmental glomerulosclerosis. It is generated by the accumulation of serum proteins in the subendothelial space, often extending into the media [16]. Arteriolosclerosis appears to be related to the loss of glomerular autoregulation and, furthermore, to participate in the pathogenesis of the associated glomerular lesions [17].