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Unilateral papillary necrosis complicating renal artery stenosis—evidence of activation of the intrarenal renin–angiotensin system?
Author(s) -
Lindop George B. M.,
Raweily Essam A.,
Graham Patricia C.
Publication year - 1991
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.1711650113
Subject(s) - renal papillary necrosis , renin–angiotensin system , medicine , necrosis , renal artery stenosis , kidney , renal artery , acute tubular necrosis , cortex (anatomy) , renal artery obstruction , hyperplasia , renal cortex , stenosis , cardiology , blood pressure , biology , neuroscience
We report an association between renal artery stenosis and papillary necrosis. We studied three kidneys with renal artery stenosis, two of which showed ipsilateral acute papillary necrosis. In all three cases there had been a sudden fall in perfusion of the ischaemic kidney. In the case with intact papillac, immunostainable renin was normal in amount and distribution, whereas both kidneys with papillary necrosis showed hyperplasia of renin‐containing cells, and these were mainly in the JGAs of the juxtamedullary cortex. Since the contralateral kidneys were spared, we suggest that in an ischaemic kidney with hyperplasia of renin‐secreting cells in the deep cortex, local activation of the renin‐angiotensin system could cause acute papillary necrosis due to vasoconstriction.