The complexity of hemorrhage-generating factors in various organs in acute kidney injury

Vol. 57 No. 2 Suppl., 2016
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Alexandru Rocsoreanu, Daniela Cernea, Cristiana Eugenia Simionescu, Eugen Mota

Bleeding disorders, associated with macroscopic and microscopic lesions in different organs are frequently found in acute kidney injury (AKI), in the third stage of the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification, treated by hemodialysis. The study included 81 cases of AKI of various causes (septic, posttraumatic, postoperative, toxic, medical nephropathies). 59.25% of the patients presented various forms of bleeding disorders (gastrointestinal bleeding, meningo-cerebral hemorrhage, epistaxis, hemodialysis vascular access bleeding, etc.). In the deceased patients that underwent necropsy, various bleeding lesions were found, involving the lungs, kidneys, brain, gastrointestinal tract and liver. A physiopathological interpretation of the factors generating these lesions and their impact on the evolution and prognosis was performed. These factors are related to the AKI s etiology, as well as the physiopathological disorders regarding the uremic syndrome and the various therapies required (blood transfusions, hemodialisys, heparin administration, surgery, macromolecule perfusion). In conclusion, multiple factors are involved in causing bleeding disorders in various organs with a major impact on the evolution and prognosis of AKI patients.

Corresponding author: Alexandru Rocsoreanu, MD, PhD Student; e-mail: rocsoreanu_alexandru@yahoo.com

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ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Florentina Grigoriu, Sorin Hostiuc, Alexandra Diana Vrapciu, Mugurel Constantin Rusu

Telocytes (TCs) are cells defined by their long and moniliform processes termed telopodes. They were previously identified in the endocardium and express neural markers, such as nestin and neuron-specific enolase (NSE). Previous studies found a positive expression of neuro-filaments in endocardial endothelial cells, and a positive expression of nestin in cardiac side population (CSP) progenitor cells, which allowed us to hypothesize that TCs in the endocardial stem niche could be in fact progenitors that express nestin. Materials and Methods: We used cardiac samples from 10 human adult donor cadavers. Endocardial endothelial cells expressed CD146, alpha-smooth muscle actin (alpha-SMA), smooth muscle myosin (SMM), nestin and, scarcely, neurofilaments. Within atrial and ventricular samples, we found an endocardial discontinuous smooth muscle layer expressing, similar to pericytes and vascular smooth muscle cells, alpha-SMA, nestin, SMM, and CD146. We assessed a similar phenotype in the subendocardial muscle layer, which also expressed neuron-specific enolase. The expression of nestin and CD146 strongly indicates a progenitor phenotype, which, in turn, supports the hypothesis that, in humans, an endocardial stem niche supplied by an endothelial-mesenchymal transition should be considered, although it mimics a primitive supply from the cardiac neural crest with dormant cardiac side population progenitor cells. Nevertheless, the endocardial niche could indeed harbor precursor cells that are morphologically similar to TCs.

Corresponding author: Mugurel Constantin Rusu, Professor, MD, PhD, Dr. Hab; e-mail: mugurel.rusu@umf.ro

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