The Relation of the Shape of Renal Papillae and of Collecting Duct Openings to Intrarenal Reflux

Papillary Morphology in Adult Human Kidneys and in Baby and Adult Pig Kidneys

“…They determined the papillary morphology on retrograde pyelograms. In contrast to both Ransley and Risdon [ 1 ] and Tamminen and Kaprio [2] they were able to demonstrate IRB in simple papillae, but at higher intrapelvic pressures than in the compound papillae. Angel et al [6] found that papillary anatomic variations may play an important role in predisposing certain kidneys or parts of a kidney to damage from either infected or sterile vesicoureteral re flux [10].…”

“…In all three groups compound papillae outnumbered as suggested in children [2], There appear to be true ana tomic variations between the two breeds of pig. The Dan-simple papillae in the upper pole (table II) and occurred ish Landrace pigs have a segmental arterial supply similar with a higher frequency there than in the other regions of to man.…”

“…It is well-known that intrarenal backflow (IRB) may occur during retrograde pyelography [1][2][3][4][5]. Opinions dif fer concerning the importance of the two different mor phologic types of papilla (simple and compound) in allowing IRB [1][2][3]6], Some authors [1,2] have sug gested that simple papillae have an anti-IRB configu ration.…”

“…Opinions dif fer concerning the importance of the two different mor phologic types of papilla (simple and compound) in allowing IRB [1][2][3]6], Some authors [1,2] have sug gested that simple papillae have an anti-IRB configu ration. However, in several retrograde pyelographies, Baby Pig Kidneys.…”

Role of Tamm-Horsfall protein in the pathogenesis of reflux nephropathy and chronic pyelonephritis

“…Subsequently, a series of observations led to the suggestion that some normal component of urine might serve as an antigenic determinant involved in the immunopathogenesis of renal scarring in vesicoureteral reflux. Specifically, (1) intrarenal reflux (IRR) was observed in some patients, mostly in children less than five years of age, who had the more severe grades of vesicoureteral reflux [33][34][35][36][37][38]; (2) intrarenal reflux occurred primarily in the polar regions of the kidney and was associated with focal renal scarring, i.e., typical reflux nephropathy [3,6,39]; (3) the polar distribution of intrarenal reflux was shown, both in children and in pigs, to be related to differences in the orifices of the ducts of Bellini, e.g., slit-like in simple single papillae, which are relatively resistant to intrarenal reflux, but wide openings in central depressions of compound papillae which occur commonly in the polar regions (about 75 percent of human kidneys have at least one compound papilla) [40][41][42]; (4) a direct relationship was observed between age and the pressure required to produce intrarenal reflux in human kidneys, i.e., lower pressures are required to produce intrarenal reflux in kidneys from younger children [6,43]; and (5) the observation that normal urinary proteins, particularly Tamm-Horsfall protein, could be detected in the renal interstitium [44,45], renal veins and lymphatics [46,47], and peri-renal lymph nodes [48,49] in association with intrarenal reflux. Thus, these observations suggested that some normal component of urine might serve as an antigenic determinant involved in the immunopathogenesis of renal scarring in vesicoureteral reflux or in other acquired states which produce retrograde urine flow.…”