Glomerular Tubular Reflux-A Morphologic Renal Lesion Associated with the Hepatorenal Syndrome

Authors

  • Gary C. Kanel,

    Corresponding author
    1. USC School of Medicine, Los Angeles, California 90033 and the USC Liver Unit, Rancho LosAmigos Hospital, Downey, California 90242
    • Gary C. Kanel, M.D., Liver Research and Education Foundation Inc., and the USC Liver Unit, Rancho Los Amigos Hospital, 1200 Building, 7705 Golondrinas Street, Downey, California 90242.
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  • Robert L. Peters

    1. USC School of Medicine, Los Angeles, California 90033 and the USC Liver Unit, Rancho LosAmigos Hospital, Downey, California 90242
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Abstract

The hepatorenal syndrome, a primary cause of death from acute and chronic liver disease, consists of a functional renal failure whereby examination of the kidney has previously shown no distinct or specific morphologic change. We describe an unusual renal lesion consisting of the reflux of proximal convoluted tubular epithelium into Bowman's space. An autopsy series shows this glomerular change to be present in 71.4% of cases with the hepatorenal syndrome, while only present in 0 to 27.3% in other autopsy categories (p < 0.001). Since this lesion has been previously described with experimental renal ischemic change and terminal hypotension, it is possible that it is caused in part by the decreased or altered renal blood flow known to be associated with the hepatorenal syndrome.

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