Arsine-Induced Anuria: A Correlative Clinicopathological Study with Electron Microscopic Observations

ROBERT C. MUEHRCKE; CONRAD L. PIRANI

doi:10.7326/0003-4819-68-4-853

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Abstract

A correlative clinicopathological study was made of a 32-year-old truck driver with arsine-induced anuria. Treatment consisted of massive exchange whole blood transfusions to remove the "arsenic-hemoglobin complex," prolonged peritoneal dialysis, and extracorporeal hemodialysis with supportive, nutritional, and medical measures as needed. Five serial renal biopsy specimens were studied by light and four by electron microscopy.

Acute tubular necrosis was followed by rapid regeneration of tubular cells. However, in the proximal tubules, these new cells had a modified and apparently functionally defective structure. Return to a normal appearance took place in a period of more than 6 months. A striking morphological feature was a diffuse interstitial fibrosis which became focal. This together with profound nephron atrophy produced irreversible chronic renal disease. A literature review was made of arsine-induced anuria, its treatment and prognosis. Finally, the morphological changes were discussed as to the damage and repair in each of the four major kidney components: tubules, glomeruli, interstitium, and vessels.

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