Kidney changes in pyloric obstruction.

Abstract

Four cases of pyloric obstruction have been studied with particular reference to the microscopic changes in the kidney. Of the four, two showed typical tetany, presumably of gastric origin. One of these was under observation only 24 hours, and was unoperated, dying shortly after admission to the hospital. The other case, in which a huge gastrectasia was demonstrated by Roentgen-ray, developed tetany following operative resection of stomach. The two cases without tetany had symtoms of gastric ulcer with signs of obstruction, and were treated surgically.

The kidney changes were not appreciated before death, and were only discovered in course of routine microscopical examination of autopsy material. The four cases show almost identical kidney changes. These consist in degeneration of cells lining the spiral and terminal straight portions of the first convoluted tubules. In many sections these cells are necrotic and infiltrated by granules staining dark blue with hematoxylin, which merge into larger masses, entirely blocking lumina of tubules. These blue staining granules we have interpreted as calcium salts whose staining reaction with hematoxylin is generally regarded as highly characteristic. Treatment of sections with 5 per cent nitric acid for 20 to 30 minutes and then staining with hematoxylin, showed complete disappearance of blue-staining material.

The changes we have found in these kidneys have long been regarded as a frequent concomitant or result of poisoning with mercuric chloride. The similarity is so marked that in our first case we were for a time entirely misled.

It must be emphasized that we do not consider these kidney changes as evidences of a nephritis. The cardinal signs and criteria of either an acute or chronic inflammatory lesion are entirely lacking. The changes we have observed are entirely of a degenerative nature, and as such are best designated by the term toxic degenerative nephrosis.