FIGURE 9-24 (see Color Plate)

Myoglobin casts in the tubules of a patient who abused cocaine. A, Hematoxylin and eosin stained casts have a dark red, coarsely granular appearance (original magnification X 250). B, Immunoperoxi-dase stain for myoglobin confirms positive staining in the casts


(original magnification X 250). These casts may obstruct the nephron, especially with dehydration and low tubular fluid flow rates. Rhabdomyolysis with formation of intrarenal myoglobin casts may also occur with severe trauma, crush injury, or extreme exercise.

FIGURE 9-25 (see Color Plate)

Apoptosis of tubular cells following tubular cell injury. Note the shrunken cells with condensed nuclei and cytoplasm in the central tubule. The patient had presumed ischemic injury (hematoxylin and eosin, original magnification X 400). The role of apoptosis in injury to the renal tubule remains to be defined. The process may be difficult to quantitate, since apoptotic cells may rapidly disintegrate. In experimental models, the degree of apoptosis versus coaggulative necrosis occurring following injury is related to the severity and duration of injury, with milder injury showing more apoptosis [9].

Disintegrating fragments

Disintegrating fragments

Phagocytosed apoptic cell fragments
Defeat Drugs Death

Defeat Drugs Death

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