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May 1948


Arch Surg. 1948;56(5):651-671. doi:10.1001/archsurg.1948.01240010661010

THE DEVELOPMENT of progressive oliguria and anuria in battle casualties resuscitated from shock and apparently on the road to recovery following extensive surgical procedures, led to the death of a significant number of severely wounded soldiers. Death usually occurred between the fourth and eighth days after the wound was incurred. At autopsy the kidneys were observed to be somewhat enlarged, and on microscopic examination pigment casts were seen in the distal convoluted and collecting tubules. The proximal tubules were dilated, and a varying degree of necrosis of the distal tubules was observed, with some inflammatory reaction in the adjacent stroma. The capillary tufts in the glomeruli showed no changes, but there was in some cases slight swelling of the cells in Bowman's capsule. This lesion has been variously termed pigment nephropathy, hemoglobinuric nephrosis and lower nephron nephrosis.

Between Jan. 1, 1944 and the end of May, 1945, 1,631 soldiers died