Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration.
OBJECTIVE
Septic shock is one of the leading causes of acute kidney injury. The mechanisms of this injury remain mostly unknown notably because of the lack of data on renal histological lesions in humans.


METHODS
Kidney biopsy was performed immediately post-mortem in consecutive patients who died of septic shock. Comparisons were made with specimens from eight patients who died of trauma on scene and nine ICU patients that died of non-septic causes.


RESULTS
Nineteen septic patients were included, 11 were male, and age was 72 +/- 12 years. Anuria occurred in all patients 2.2 +/- 1.4 days before death. Seven patients had disseminated intravascular coagulation. In all patients we observed (1) acute tubular lesions whose intensity correlated with blood lactate concentration; (2) intense infiltration by leukocytes, mainly monocytic, in glomeruli and interstitial capillaries as compared to controls; (3) presence of tubular cell apoptosis proved by the presence of apoptotic bodies (2.9% of tubular cells) significantly more frequently than in controls and confirmed by TUNEL and activated caspase-3 staining. Arteriolar/arterial thromboses were observed in only 4 of 19 patients, without any association with presence of disseminated intravascular coagulation.


CONCLUSIONS
Kidney lesions in septic shock go beyond those associated with simple acute tubular injury, notably capillary leukocytic infiltration and apoptosis. Vascular thrombosis, however, did not appear to play a major role in the majority of patients. The extent to which these lesions are specific to sepsis or are common to all multi-organ failure independent of its cause is yet to be elucidated. Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1723-x) contains supplementary material, which is available to authorized users.
Lerolle
Nicolas
N
Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalo-Universitaire d'Angers, 49933 Angers Cedex, France. nilerolle@chu-angers.fr
Nochy
Dominique
D
Guérot
Emmanuel
E
Bruneval
Patrick
P
Fagon
Jean-Yves
JY
Diehl
Jean-Luc
JL
Hill
Gary
G
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D001706:Biopsy; D002465:Cell Movement; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D007962:Leukocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications*; D055815:Young Adult