Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal eclampsia and suppression of urine

Abstract

SUPPRESSION of urine appears to be one of the rarer complications of the puerperium, and to depend upon a variety of lesions.Widespread necrosis of the cortex of the kidneys has been found in association with it in only about half a dozen cases, so that it must be an extremely rare lesion.The first case of which we are aware was that published by Rose Bradford and Lawrence in 1898, and there is little to be added to the account which they have given of the histology of the condition.Since then cases have been recorded by Griffith and Herringham, H. C. Lloyd, Klotz, and the first of the present cases was reported in another place by Jardine.Clinically the cams present considerable variation in details, but all agree in the association of the puerperium, the presence of fits, and the absence of the usual uremic phenomena.In most of the cases suppression of urine was not complete.Pathologically, the cases are practically identical.The leading features are symmetrical necrosis of the greater part of the cortex of the kidneys, which appears to be due to the presence of thrombi in the small interlobular and straight arteries of the cortex.In Lloyd's case the thrombi are described as agglutinations of red blood corpuscles ; in the rest they were of the amorphous variety.The condition wa8 clearly one of thrombosis-not of embolism.The cause of the thrombosis remains unknown.