Pathology of acute renal failure: structure/function correlations

Acute renal failure can be fully understood only in the context of an understanding of the morphological changes that underlie or reflect functional changes occurring in the kidney. This review emphasizes morphological findings in the most common form of acute renal failure, so-called acute tubular necrosis. Morphological findings in acute renal failure are discussed, with particular attention to changes in tubular cells with sublethal injury, and changes of apoptotic cell death. It is emphasized that pathogenic mechanisms and morphological changes are complex and interdependent, and in some cases evanescent, making correlation of a single morphological finding to functional end points difficult, especially in the setting of clinical renal injury. It is the constellation of morphological findings that should be assessed to establish the most meaningful correlation with function.