Figure 49

Macroscopy and microradioangiographs of sickle cell kidneys. The kidneys of patients with sickle cell disease usually are of near normal size, and most kidneys show no significant gross alterations. Abnormalities can be expected in the renal medulla as erythrocytes form sickles more readily in the relatively hypoxic and hyperosmotic renal medulla than in other capillary circulations. Formation of microthrombi causes further impairment of the vasa recta circulation. A and B, Injection microradioangiographs of the kidney in a person without hemoglobinopathy are shown: the entire kidney (panel A) and a detailed view (panel B). C and D, Injection microradioangiographs of the kidney in a patient with sickle cell disease are shown: the entire kidney (panel C) and a detailed view (panel D). E, Injection microradioangiograph of a kidney in a patient with sickle cell hemoglobin C disease . In the normal kidney (panel A), vasa recta are visible radiating into the renal papilla. In sickle cell anemia (panel D), vasa recta are virtually absent. Those vessels that are present show abnormalities: they are dilated, form spirals, end bluntly, and many appear to be obliterated. In the patient with hemoglobin SC (panel E) changes are seen intermediately between patients with hemoglobin SC and normal persons. (From van Eps et al. [5]; with permission.)

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