Intrarenal vascular alterations in hemodialysis patients. A semiquantitative light microscopic study

The intrarenal arterial and arteriolar changes in the kidneys of 80 patients with chronic renal insufficiency maintained on hemodialysis were studied semiquantitatively by light microscopy and histochemistry. Intimal proliferation was common and accounted for thickening of vessel walls and luminal narrowing. Fibrocollagenous and fibroelastotic intimal changes were located predominantly in the interlobular and arcuate arteries, whereas the fibromucinous intimal lesion was found mainly in the interlobar arteries. Thickening of the media was encountered in 25 per cent, and adventitial fibrosis in 20 per cent of the kidneys. Necrotizing arterial of arteriolar lesions were not seen. The significance of these alterations as a possible cause of renal ischemia and their role in the perpetuation of hypertension are discussed.