The renal lesions of electrolyte imbalance. I. The structural alterations in potassium-depleted rats.

Renal tubular lesions during the early phases of progressive potassium depletion in rats were found in nephrons isolated by microdissection in two locations, the collecting tubules and the proximal convolutions. All other portions of the nephron, in particular the "distal tubule," i.e. ascending limbs of Henle's loop and distal convolutions, showed no structural alterations except the passive effects of dilatation and cellular compression which developed as a result of primary disturbances lower in the tubular system. The alterations affected all the collecting tubules uniformly and took two forms; the more severe, a swelling and hyperplasia of the tubular epithelium and the lesser, an intracellular accumulation of granule droplets. The former was limited to the outer zone of the medulla, the latter to its inner zone. In the proximal convolution the structural alteration began in its middle third and extended downward towards the medulla; only occasional nephrons were affected. The essential nature of the more severe epithelial lesion was similar in both collecting tubule and proximal convolution, beginning as a swelling of cell bodies, increasing to protoplasmic disturbances with disintegration of the mitochondrial pattern, followed by rupture of cells and nuclear disappearance. These retrogressive alterations were followed by prolific regenerative hyperplasia. In the collecting tubules of the outer zone these epithelial alterations were present in both the clear and the intercalcated cells; in the latter the swelling of the cells was not prominent, but the hyperplastic proliferative increase in their number was the predominating feature of the lesion when the dissected tubules were viewed intact in the continuity of their topographical relations. The cellular alterations in the tubules are associated with an inability to concentrate the urine; reasons are given for considering this functional disturbance a correlate of the structural lesion in the collecting tubules.