November 1967

An Unusual Nephritis in Malignant Hypertension

Author Affiliations

Bethesda, Md, and Washington, DC

From the Section of Pathology, Clinic of Surgery, National Heart Institute, National Institutes of Health, Bethesda, Md, and the Department of Pathology, District of Columbia General Hospital, Washington, DC.

Arch Intern Med. 1967;120(5):625-630. doi:10.1001/archinte.1967.00300040109020

IN 1932 Rich 1 described a peculiar and morphologically unique nephritis with two distinctive histologic features: (1) focal spherical nodules of interstitial, chronic, inflammatory cells which invaginated the walls of tubules into their lumina, and (2) the presence in the tubular lumina of cholesterol crystals associated with degenerating epithelial cells, polymorphonuclear leukocytes, and lipidladen macrophages. Since Rich's report, only one subsequent paper2 describing this form of nephritis has appeared, although similar lesions were illustrated in the monographs of Allen3 and Heptinstall.4 In 25 other texts and monographs on renal disease published during the past 30 years either no mention is made of this focal, interstitial nephritis or Rich's observations are simply summarized. Recently, we encountered this lesion in a patient who died of malignant hypertension, and the clinicopathologic findings in him are summarized in the report which follows.

Report of a Case  A 26-year-old Negro man (DCGH

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