Abstract
Uremic pneumonitis is included in the “adult respiratory distress syndrome”. Diffuse alveolo-capillary damage, interstitial and intraalveolar edema, widespread atelectases, alveolar haemorrhages and pulmonary hyaline membranes are characteristic but not pathognomonic findigns in uremic pneumonitits. Investigations showed that uremic pneumonitis results from diffuse permeability disorders of the alveolo-capillary permeability combined with an intrarenal or generalized consumption of coagulation factors, and a subsequent state of hypercoagulability. A comparative morphological and clinical analysis of 66 autopsy cases with severe uremia showed that neither the intensity of the urea retention nor the intensity of the creatinine retention correlate with the morphologic symptoms of uremic pneumonitis. Uremia may induce the basic alveolocapillary damage and the subsequent plasmatic leakage into the alveoli and alveolar ducts but uremia has obviously no influence on the simultaneous formation of pulmonary hyaline membranes and intraalveolar bleedings. Hyaline membranes and intraalveolar bleedings are the entire equivalents of the immediate procoagulative activity of the underlying diseases.
Similar content being viewed by others
References
Adamson JYR, Bowden DH (1974) The pathogenesis of bleomycin-induced pulmonary fibrosis in mice. Am J Pathol 77:185
Bedrossian CWM, Luna MA, MacKay B, Lichtiger B (1973) Ultrastructure of pulmonary bleomycin toxicity. Cancer 32:44
Benzer H (1975) Oberflächenspannung in der Lunge und Schocklunge. Verh Dtsch Ges Inn Med 81:455
Bleyl U (1971) Pathomorphologie und Pathogenese des Atemnotsyndroms. Verh Dtsch Ges Pathol 55:39
Bleyl U (1977) Morphologic diagnosis of disseminated intravascular coagulation: histologic, histochemical and electronmicroscopic studies. Semin Thromb Hemostas 3:247
Bleyl U (1978) Hamostase und Schocklunge. Verh Dtsch Ges Pathol 62:39
Bleyl U (1979) Die Histophysiologie und Histopathologie der terminalen Lungenstrombahn bei akutem Lungenversagen. In: Ahnefeld FW, Bergmann H, Burni C, Dick W, Halmagyi M, Hossli G, Rügheimer E (eds) Akutes Lungenversagen. Springer, Berlin Heidelberg, New York, pp 1–13
Bleyl U, Büsing CM (1973) Pathogenese pulmonaler hyaliner Membranen. In: Wiemers K, Scholler KL (eds) Lungenveränderungen bei Langzeitbeatmung. Internat Symposium Freiburg 1971. Thieme, Stuttgart, pp 19–26
Bleyl U, Büsing CM, Krempien B (1969) Pulmonale hyaline Membranen und perinataler Kreislaufschock. Virchows Arch [Pathol Anat] 348:187
Bleyl U, Heilmann K, Adler D (1971) Generalisierte plasmatische Hyperkoagulabilität und pulmonale hyaline Membranen. Klin Wochenschr 49:71
Bleyl U, Werner C (1972) Zur Pathomorphologie der urämischen Pneumonitis. Verh Disch Ges Pathol 56:663
Bleyl U, Werner C, Büsing CM (1978) Zur Pathogenese der urämischen Pneumonitis. Klin Wochenschr 56:121
Bohle U, Helmchen U, Grund KE, Gärtner HV, Meyer D, Bock KD, Bulla M, Bünger P, Scheler F, Christ H (1977) Malignant nephrosclerosis in patients with hemolytic uremic syndrome (primary malignant nephrosclerosis). Curr Top Pathol 65:81
Büsing CM, Bleyl U (1974) Oxygen induced pulmonary hyaline membranes (PHM) and disseminated intravascular coagulation (DIC). Virchows Arch [Pathol Anat] 363:113
Burkhardt A, Gebbers J-O, Höltje W-J (1977) Die Bleomycinlunge. Dtsch Med Wochenschr 102:281
Cooke NJ, Flenley DC, Matthew H (1973) Paraquat polsoning: Serial studies of lung function. Q J Med 42:683
Crosbie WA, Snowden S, Parsons V (1972) Changes in lung capillary permeability in renal failure. Br Med J 4:388
Gould NJ, Miller J (1975) Sclenosing alveolitis induced by cyclophosphamide. Am J Pathol 81:513
Heard BE, Cooke RA (1968) Busulphan lung. Thorax 23:187
Heshiki Y, Johnson JWC, Permutt S (1969) Further studies on the inhibition of surfactant by plasma. Clin Res 17:415
Hopps HC, Wissler RW (1955) Uremic pneumonitis. Am J Pathol 31:261
Kapanci Y, Weibel ER, Kaplan HP, Robinson FR (1969) Pathogenesis and reversibility of the pulmonary lesion of oxygen toxicity in monkeys. II. Ultrastructural and morphometric studies. Lab Invest 20:101
Katzenstein AL, Bloor CM, Liebow AA (1976) Diffuse alveolar damage — the role of oxygen, shock and related factors. Am J Pathol 85:210
Kirschner RH, Esterly JR (1971) Pulmonary lesions associated with busulphan therapy of chronic myelogenous leukemia. Cancer 27:1074
Levine OR, Mellins RB (1975) Liquid balance in the lung and pulmonary edema. In: Scardelli E (ed) Pulmonary physiology of the fetus, newborn and child. Lea & Febinger, Philadelphia, p 238
Mittermayer C, Hagedorn M, Böttcher D, Vogel W, Neuhof H, Mittermayer U (1972) Bromcarbamidvergiftung, ein Modell der Schocklunge. Klin Wochenschr 50:467
Murray JF (1976) The normal lung. Saunders, Philadelphia London Toronto
Nash G, Foley FD, Langlinais PC (1974) Pulmonary interstitial edema and hyaline membranes in adult burn patients: electron microscope observations. Hum Pathol 5:149
Necek S (1979) Der pulmonale, transvaskuläre und transalveoläre Flüssigkeits- und Proteintransport bei normaler und gestörter Lungenfunktion. In: Ahnefeld FW, Bergmann H, Burri C, Dick W, Halmagyi M, Hossli G, Rügheimer E (eds) Springer, Berlin Heidelberg New York, p 36–42
Oliner H, Schwartz R, Rubio F, Dameshek W (1961) Interstitial pulmonary fibrosis following busulphan therapy. Am J Med 31:134
Petty TL (1975) The adult respiratory distress syndrome (confessions of a “lumper”). Am Rev Respir Dis 111:713
Petty TL, Ashbaugh D (1970) The adult respiratory distress syndrome. Chest 60:233
Rüfer R, Stolz C (1969) Inaktivierung von alveolären Oberflächenfilmen durch Erniedrigung der Oberflächenspannung der Hypophase. Pfluegers Arch 307:89
Schneeberger EE (1976) Ultrastructural basis for alveolar capillary permeability to protein. In: Ciba Foundation (ed) Lung liquids. Elsevier Excerpta Medica, North Holland, Amsterdam Oxford New York, pp 299–300
Taylor FB Jr, Abrams ME (1964) Inhibition of clot lysis by a surface active lipoprotein from lung and inhibition of its surface activity by fibrinogen. Physiologist 7:269
Taylor FB Jr, Abrams ME (1966) Effect of surface active lipoprotein on clotting and fibrinolysis, and of fibrinogen on surface tension of surface active lipoprotein. Am J Med 40:346
Toner POG, Vetters JM, Spilg WGS, Harland WA (1970) Fine structure of the lung lesion in a case of paraquat poisoning. J Pathol 102:182
Wichert P v (1978) Alveolarwandphysiologie und Surfactant. Verh Dtsch Ges Pathol 62:29
Wichert P v, Eckert P, Stephan U, Wiegers U (1976) Verminderung der Synthese oberflächenaktiven Lecithins in den Lungen peritonitischer Ratten und Gehalt an Dipalmitoyllecithin (DPL) in Lungen von Patienten mit sogenannter Schocklunge. Intensivmedizin 13 (Suppl):1
Wichert P v, Kohl FV (1977) Decreased dipalmitoyllecithin content found in lung specimens from patients with so-called shock-lung. Intensive Care Med 3:27
Author information
Authors and Affiliations
Additional information
Dedicated to Professor Dr. Johannes Linzbach, Göttingen, on the occasion of his 70th birthday
Rights and permissions
About this article
Cite this article
Bleyl, U., Sander, E. & Schindler, T. The pathology and biology of uremic pneumonitis. Intensive Care Med 7, 193–202 (1981). https://doi.org/10.1007/BF01724840
Issue Date:
DOI: https://doi.org/10.1007/BF01724840