Participation of intravascular coagulation in the pathogenesis of glomerular and vascular lesions

Evidence of both generalized and localized intravascular coagulation can be found in a wide variety of diseases which cause lesions of glomeruli, arteries and arterioles in the kidney.In conditions in which fibrin is deposited in vessels or glomeruli, the clinical course and morphological evolution of the lesions vary widely. In the most benign type of glomerular lesion, namely that of acute tubular necrosis, in spite of well-documented evidence of coagulation within glomeruli [1–3], lesions are mild and appear to be fully reversible. At the other end of the scale, where abundant fibrin is present as in the thrombotic microangiopathies, scleroderma and malignant hypertension, total occlusion of vessels and glomeruli progresses rapidly in untreated patients and a uremic death is common. Pre-eclamptic toxemia occupies an intermediate position. The similarities and differences within this group of diseases are discussed and illustrated