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Glomerular volume in congestive cardiac failure
J D Walker1, B Burke, M W Steffes
1Department of Laboratory Medicine and Pathology, UMHC, University of Minnesota, Minneapolis, USA.
Insights
Congestive cardiac failure (CCF) does not significantly enlarge glomeruli. Previously observed glomerular enlargement in cyanotic heart disease may be due to hypoxemia, not CCF itself.
Area of Science:
- Nephrology
- Cardiology
- Pathology
Background:
- Glomerular volume is elevated in cyanotic heart disease and cor pulmonale.
- The effect of congestive cardiac failure (CCF) on glomerular volume is not well-established.
- Previous studies suggest a link between cardiac conditions and kidney morphology.
Purpose of the Study:
- To investigate whether severe congestive cardiac failure (CCF) is associated with glomerular enlargement.
- To compare glomerular volume in patients with CCF to age-matched controls.
- To differentiate the effects of CCF from hypoxemia on glomerular size.
Main Methods:
- Glomerular volume was measured using the Cavalieri principle with point-counting on serially sectioned glomerular profiles.
- Autopsy specimens from 8 patients with CCF and 6 healthy controls were analyzed.
- 25 glomeruli were randomly selected from each specimen for volumetric analysis.
Main Results:
- Mean glomerular volume was not significantly different between patients with CCF (2.49 ± 0.21 x 10^6 µm³) and controls (2.25 ± 0.26 x 10^6 µm³).
- The distribution of individual glomerular volumes was similar in both groups.
- No significant glomerular enlargement was observed in patients with severe CCF.
Conclusions:
- Severe congestive cardiac failure (CCF) is not associated with significant glomerular enlargement.
- Glomerular enlargement in cyanotic heart disease is likely mediated by hypoxemia, rather than the cardiac failure itself.
- These findings help clarify the pathophysiology of renal changes in heart disease.
Abstract:
Glomerular volume has been reported to be increased in patients with congenital cyanotic heart disease and cor pulmonale; however it has not been systematically studied in patients with congestive cardiac failure (CCF). Glomerular volume was therefore measured by point-counting serially sectioned glomerular profiles of 25 randomly selected glomeruli using the Cavalieri principle in autopsy specimens from 8 patients dying from CCF and 6 age-matched controls with no renal or cardiac pathology. Mean glomerular volume was not different between patients dying from CCF and controls, 2.49 (0.21) vs. 2.25 (0.26) x 10(6) microm3, and the distribution of individual glomerular volumes was similar in the two groups. We conclude that severe CCF is not associated with significant glomerular enlargement and that the previously reported glomerular enlargement in cyanotic heart disease is likely to be mediated through hypoxemia.