RENAL CHANGES IN SECONDARY SHOCK

Abstract

Twelve cases of delayed death following acute or incipient shock produced by (1) a reaction to transfusion of incompatible blood, (2) perforated cholecystitis and bile peritonitis, (3) ulcerative esophagitis, enteritis and colitis, (4) pneumonia, (5) intestinal obstruction, (6) subdiaphragmatic abscess, (7) burns, (8) Hodgkin''s disease with tissue necrosis, (9) obstructive jaundice, (10) bichloride of Hg poisoning, (11) neoarsphenamine poisoning and (12) diffuse hepatic necrosis caused by sulfadiazine are presented. Clinically there were varying degrees of oliguria, high sp. gr. of the urine with albumin, casts, erythrocytes and pus cells, and a retention of NPN in the blood. Grossly the kidneys show edema. Microscopically there are interstitial congestion and edema with or without cellular infiltration, degeneration to necrosis of the proximal convuluted tubules, casts within the tubules, and congestion and edema of the glomeruli. Although the ultimate causes of the renal changes are divergent one denominator common to many of the cases is shock and, therefore, these changes are regarded as characteristic of this phenomenon.