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The Sequence of Events in the Development of Bilateral Renal Cortical Necrosis Accompanying the Generalized Shwartzman Reaction

Rekkefølgen i utviklingen av de patologisk-anatomiske forandringer ved dobbeltsidig nyrebarknekrose og den generaliserte Shwartzman’s reaksjon

Acta Veterinaria Scandinavica volume 18, pages 522–531 (1977)Cite this article

Abstract

The generalized Shwartzman reaction, or Shwartzman-like conditions, were induced in a variety of experimental mammalian species by systemic injections of disintegrated cells of Gram negative bacteria, live Salmonella cholerae-suis or Liquoid. A comparative study of the renal lesions showed that the initial step in the development of bilateral cortical necrosis is stagnation and disintegration of red cells in glomerular capillaries. The glomerular “microthrombi” consist mainly of erythrocytic debris, which frequently has staining properties akin to those of fibrin; even wide-spread glomerular “thrombosis” is not accompanied by obvious destruction of renal parenchyma. A second step is necrotic mural lesions in afferent arteries, with ensuing thrombosis. These vascular lesions lead to the formation of individual infarcts which fuse to form total bilateral cortical necrosis in fulminant cases of the generalized Shwartzman reaction.

Sammendrag

Generalisert Shwartzman’s reaksjon, eller Shwartzman’s lignende tilstander, ble framkalt hos en rekke arter av pattedyr ved injeksjon av disintegrerte Gram negative bakterier, levende Salmonella choleraesuis, eller Liquoid. En komparativ studie av nyreskaden viste at de først registrerbare forandringer i glomeruli er stase og disintegrering av røde blodlegemer i kapillærene i glomeruli. „Mikrotrombene“ i glomeruli består vesentlig av henfallende erytrocytter; dette materialet har ofte samme fargeegenskaper som fibrin. Selv uttalte „tromboseringer“ i glomeruli er ikke ledsaget av tydelige makroskopiske henfallsprosesser i nyreparenchymet. Et neste skritt er utvikling av nekrotiserende forandringer i veggen av afferente arterier; disse karveggsforandringene er ofte ledsaget av tromboseringer. Karforandringene fører til dannelse av infarkter som så flyter sammen og gir total nyrebarknekrose i fulminante tilfeller av den generaliserte Shwartzman’s reaksjon.

References

  • Ash J. E.: Bilateral cortical necrosis of the kidneys (angioneurotic anuria). Amer. J. med. Sci. 1933, 185, 71–86.

    Article  Google Scholar 

  • Bohle A. H. Sitte & F. Miller: Elektronenmikroskopische Untersuchungen am Glomerulum des Kaninchens beim generalisierten Shwartzman-Phänomen. (Electron microscopic investigations of glomerulus of rabbits in the generalized Shwartzman phenomenon). Verh. dtsch. Ges. Path. 1957, 41, 326–332.

    Google Scholar 

  • Collins A. D. E. C. Henson, S. R. Izard & J. G. Brunson: Norepinephrine, endotoxin shock, and the generalized Shwartzman reaction. Arch. Path. 1972, 93, 82–88.

    CAS  PubMed  Google Scholar 

  • De Navasguez S.: The histology and pathogenesis of bilateral cortical necrosis of the kidney in pregnancy. J. Path. Bact. 1935, 41, 385–396.

    Article  Google Scholar 

  • Duff G. L. & R. H. More: Bilateral cortical necrosis of the kidneys. Amer. J. med. Sci. 1941, 201, 428–450.

    Article  Google Scholar 

  • Evensen S. A. & D. Shepro: Generalized Shwartzman reaction induced by Liquoid in the rat. Increased DNA-synthesis in aortic endothelium. Thrombos. Diathes. haemorrh. (Stuttg.) 1973, 30, 347–351.

    CAS  Google Scholar 

  • French R. W.: Acute necrosis of the kidneys. Report of a case. Amer. J. Surg. 1940, 47, 666–669.

    Google Scholar 

  • Friedländer C: Ueber Nephritis scarlatinosa. (On scarlatinal nephritis). Fortschr. Med. 1883, 1, 81–89.

    Google Scholar 

  • Gaarder A. J. Jonsen, S. Laland, A. Hellem & P. A. Owren: Adenosine diphosphate in red cells as a factor in the adhesiveness of human blood platelets. Nature (Lond.) 1961, 192, 531–532.

    Article  CAS  Google Scholar 

  • Gáspár I. A.: Bilateral cortical necrosis of the kidneys. Amer. J. clin. Path. 1938, 8, 281–301.

    Article  Google Scholar 

  • Gaynor E. C. Bouvier & T. H. Spaet: Vascular lesions: Possible pathogenetic basis of the generalized Shwartzman reaction. Science 1970, 170, 986–988.

    Article  CAS  PubMed  Google Scholar 

  • Geipel P.: Nierenrindennekrose und Fleckmilz bei Eklampsie. (Renal cortical necrosis and spotted spleen in eclampsia). Arch. Gynäk. 1925, 124, 231–240.

    Article  Google Scholar 

  • Gerrity R. G. B. A. Caplan, M. Richardson, J. F. Cade, J. Hirsh & C. J. Schwartz: Endotoxin-induced endothelial injury and repair. I. Endothelial cell turnover in the aorta of the rabbit. Exp. Molec. Path. 1975, 23, 379–385.

    Article  CAS  PubMed  Google Scholar 

  • Gilbert R. P.: Mechanisms of the hemodynamic effects of endotoxin. Physiol. Rev. 1960, 40, 245–279.

    Article  CAS  PubMed  Google Scholar 

  • Good R. A. & L. Thomas: Studies on the generalized Shwartzman reaction. IV. Prevention of the local and generalized Shwartzman reaction with heparin. J. exp. Med. 1953, 97, 871–888.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hoff H. F. R. Gottlob & G. Blümel: Ultrastructural changes in arteries induced by endotoxin. Naturwissenschaften 1967, 54, 287–288.

    Article  CAS  PubMed  Google Scholar 

  • Hughes A. & R. S. Tonks: Intravascular platelet clumping in rabbits. J. Path. Bact. 1962, 84, 379–390.

    Article  CAS  PubMed  Google Scholar 

  • Jørgensen L. T. Hovig, H. C. Rowsell & J. F. Mustard: Adenosine diphosphate-induced platelet aggregation and vascular injury in swine and rabbits. Amer. J. Path. 1970, 61, 161–176.

    PubMed  PubMed Central  Google Scholar 

  • Kreyberg L.: Über präcanceröse Gefässveränderungen. (On precancerous vascular changes). Virchows Arch. path. Anat. 1929, 273, 367–440.

    Article  Google Scholar 

  • Kreyberg L.: Stasis and Necrosis. Universitetsforlaget, Oslo 1963.

    Google Scholar 

  • Lambert P. B. S.-C Ming & C. Palmerio: Vasomotor factors in the Shwartzman phenomenon. Amer. J. Path. 1969, 57, 559–580.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Lendrum A. C. D. S. Fraser, W. Slidders & R. Henderson: Studies on the character and staining of fibrin. J. clin. Path. 1962, 15, 401–413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McKay D. G.: Disseminated Intravascular Coagulation. An Intermediary Mechanism of Disease. Hoeber Medical Division, New York 1965.

    Google Scholar 

  • More R. H. & S. D. Kobernick: Arteritis, carditis and glomerulonephritis and bilateral renal cortical necrosis induced in rabbits, by injection of horse serum or bovine gamma globulin combined with killed group A streptococci or Freund’s adjuvant. Arch. Path. 1951, 51, 361–378.

    CAS  Google Scholar 

  • Nordstoga K.: Porcine salmonellosis: A counterpart to the generalized Shwartzman reaction. Origin of hyaline material precipitated in minute vessels. Acta path, microbiol. scand. Sect. A 1974, 82, 690–702.

    CAS  Google Scholar 

  • Nordstoga K.: Liquoid-induced arterial lesions and the generalized Shwartzman reaction. Acta vet. scand. 1977, 18, 515–521.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Nordstoga K. & M. Fjølstad: The generalized Shwartzman reaction and Haemophilus infections in pigs. Path. Vet. 1967, 4, 245–253.

    CAS  Google Scholar 

  • Nordstoga K. & M. Fjølstad: Porcine salmonellosis. II. Production of the generalized Shwartzman reaction by intravenous injections of disintegrated cells of Salmonella cholerae-suis. Acta vet. scand. 1970, 11, 370–379.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nordstoga K. & M. Fjølstad: Necrotizing angiitis produced by the Shwartzman mechanism. Acta path, microbiol. scand. Sect. A, 1973, 81, 775–783.

    CAS  Google Scholar 

  • Nordstoga K. & M. Fjølstad: Pulmonary vascular lesions in chickens following intravenous injections of disintegrated cells of Escherichia coli. Acta path. microbiol. scand. Sect. A, 1975, 83, 283–291.

    CAS  Google Scholar 

  • Röhrer H.: Pathologisch-anatomische und histologische Studien bei akuter Schweinepest, insbesondere an Leber und Niere. Mit einem Anhang über totale Nierenrindennekrosen. (Pathologic-anatomic and histologic studies on acute swine fever, with special reference to liver and kidney. With an addendum on total renal cortical necroses). Virchows Arch. path. Anat. 1932, 284, 203–230.

    Article  Google Scholar 

  • Scriver W. de M. & H. Oertel: Necrotic sequestration of the kidneys in pregnancy (symmetrical cortical necrosis). A clinical and anatomic-pathogenetic study. J. Path. Bact. 1930, 35, 1071–1094.

    Article  Google Scholar 

  • Shapiro S. S. & D. G. McKay: The prevention of the generalized Shwartzman reaction with sodium warfarin. J. exp. Med. 1958, 107, 377–381.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stewart G. J. & M. J. Anderson: An ultrastructural study of endotoxin induced damage in rabbit mesenteric arteries. Brit. J. exp. Path. 1971, 52, 75–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Still W. J. S. & G. B. D. Scott: An electron microscopic study of the endothelial changes and the nature of “fibrinoid” produced in the generalized Shwartzman reaction. Exp. Molec. Path. 1966, 5, 118–124.

    Article  CAS  PubMed  Google Scholar 

  • Stoeckenius W.: Über fast vollständige doppelseitige Nierenrinden-nekrose bei Diphtherie. (On almost complete bilateral renal cortical necrosis in diphtheria). Beitr. path. Anat. 1921, 69, 373–379.

    Google Scholar 

  • Thomas L. & R. A. Good: Studies on the generalized Shwartzman reaction. I. General observations concerning the phenomenon. J. exp. Med. 1952, 96, 605–624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Urizar R. E. G. Sherer, A. Tartaglia, R. J. Pickering & W. J. Dodds: Disseminated intravascular coagulation induced by Liquoid in the rat. I. Correlation of hematologic and complement abnormalities with renal lesions studied by light, fluorescence, and electron microscopy. Lab. Invest. 1975, 32, 270–278.

    CAS  PubMed  Google Scholar 

  • von Zalka E.: Über symmetrische Rindennekrose der Niere. (On symmetrical renal cortical necrosis). Virchows Arch. path. Anat. 1933, 290, 53–70.

    Article  Google Scholar 

  • Watchi J. M. & J. Altman: Role of ureteric pressure in protecting the kidney against cortical necrosis during the Sanarelli-Shwartz-man reaction: An argument in favour of the primary role of vascular spasm in the mechanism of cortical necrosis. Rev. europ. Étud. Clin. biol. 1972, 17, 982–987.

    CAS  Google Scholar 

  • Zeek P. M.: Periarteritis nodosa: A critical review. Amer. J. clin. Path. 1952, 22, 777–790.

    Article  CAS  Google Scholar 

  • Zeek P. M. C. C. Smith & J. C. Weeter: Studies on periarteritis nodosa. III. The differentiation between the vascular lesions of periarteritis nodosa and of hypersensitivity. Amer. J. Path. 1948, 24, 889–917.

    CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

The author is indebted to Professor, Dr. med. H. Stormorken, for valuable discussions during the preparation of this paper.

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  1. Department of Pathology, Veterinary College of Norway, P.O. Box 8146, Oslo Dep., Oslo 1, Oslo, Norway

    Knut Nordstoga

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Nordstoga, K. The Sequence of Events in the Development of Bilateral Renal Cortical Necrosis Accompanying the Generalized Shwartzman Reaction. Acta Vet Scand 18, 522–531 (1977). https://doi.org/10.1186/BF03548416

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Acta Veterinaria Scandinavica

ISSN: 1751-0147