ATROPHIC KIDNEY DUE TO CHRONIC ISCHAEMIA
The specimen was an incidental finding at post mortem in a patient who died of metastatic carcinoma of colon and pulmonary oedema. She had a past history of cardiac disease and impaired renal function.
The specimen consists of right and left kidneys, the aorta and both renal arteries. The aorta has been opened from behind and both kidneys have been sectioned coronally and mounted to display the cut surfaces. The aorta shows gross changes of atherosclerosis with focal ulceration. The left renal artery is smaller than the right and its origin is completely blocked by organized thrombus. The lumen of the renal artery distal to the thrombus is severely reduced. The origin of the right renal artery is severely narrowed by atheroma. The left kidney is much smaller than the right. The cortical surface is relatively smooth and all parts of the kidney are reduced in size, suggesting atrophy secondary to chronic ischaemia. The right kidney shows changes of benign nephrosclerosis, i.e. fine granularity of the cortical surface and reduction in cortical width. In addition, a small cortical adenoma measuring 1 cm in diameter is present at the lower pole of the right kidney. The left kidney has been protected from hypertensive damage.
The occlusion of the left renal artery was probably due to thrombo-embolism originating from either the heart or from an aortic atheromatous plaque. Atheroma of the renal arteries is rarely severe enough to interfere with renal circulation, except in diabetics. However, partial or complete occlusion of the origin of the renal artery may be caused by an aortic atheromatous plaque. This is a rare but important cause of systemic hypertension, as it may be amenable to surgical treatment.