FUNCTIONAL PATTERNS IN RENAL DISEASE

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Abstract
The patterns of renal functional disturbances are described in a wide variety of clinical disord ers and are shown to correspond generally with independent estimates of underlying functional and structural changes. In hypertensive vascular disease it is concluded that (a) in early essential hypertension the only measurable renal abnormality is an increase of afferent resistance but that (b) as the disease advances, renal vaso-constriction becomes more intense and extends to the efferent arterioles, is associated with renal ischemia, arteriolarsclerosis and loss of tissue. (c) The pattern in malignant hypertension is an exaggeration of these changes. (d) Arteriosclerotic hypertension is associated with evidences of focal obliteration of afferent arterial channels. The patterns in chronic pyelonephritis are diverse and dependent on the stage of the disease and the presence or absence of hypertension. The pattern in diffuse glomerulone-phritis, acute and chronic, is essentially one of glomerular damage. The terminal stage is associated with a severe loss of tubular secretory tissue. The pattern of intercapillary glomerulosclerosis resembles that of chronic glomerulo-nephritis, while that of specific toxemia of pregnancy is similar to that of acute glomerulonephritis. The patterns in toxic nephroses and in functional disorders, such as ortho-static hypotension, are described. It is concluded that the estimates obtained from the new tests of renal function adequately reflect the nature of renal disorders.