18165              POLYARTERITIS NODOSA

A man of 61 presented 2 months before his death with haematuria.  A month later there were petechial haemorrhages in the skin and blood in the sputum.  Coagulation studies showed a bleeding time of 7 minutes but no other abnormalities.  On admission to the ward there was acute pulmonary oedema and the B.P. was 230/160, blood urea 65, serum sodium 133 m.eq/1. and potassium 4 m.eq/1.  The BUN rose to 99 and he continued to have features of pulmonary oedema and renal failure.  He died of pulmonary oedema.  At postmortem generalised oedema was found together with myocardial infarction and blotchy kidneys.

The specimen consists of a kidney which measures 10 cms in length.  The capsule strips readily to disclose a rather blotchy surface in which pale irregular areas 1-3 mms in diameter are set in a rather irregularly congested background.  The cut surface shows slight diminution of cortical thickness together with marked blotchy alternation of small pale areas and congested areas.  The pyramids are relatively little affected.  There is some acute haemorrhage beneath the mucosa of the upper calyx.  Histology shows marked fibrinoid degeneration of smaller renal vessels with cellular hyperplasia of the intima and the media.  There is no perivascular inflammation.  Glomeruli show only fibrinoid necrosis with no evidence of cellular proliferation or crescents.