Renal failure is an uncommon manifestation of HVS, and may result from perturbations in renal perfusion, leading to ischemic injury of the kidney. In experimental animal models, the influence of blood rheol-ogy on glomerular hemodynamics has been investigated. Elevation of either serum or whole blood viscosity resulted in renal vasodilation and decreased renal blood flow.4142 Ischemic acute tubular necrosis as a result of HVS has also been reported in a patient with WM.43 In HVS-related renal dysfunction, decreased urine output, defects in concentrating and diluting urine, and increased serum creatinine may be observed.43 In such cases, a kidney biopsy can be considered. Increased mesangial matrix, cytoplasmatic vacuolation of the epithelial cells lining the proximal tubules, foci of atypical lymphoplasmacytoid infiltration in the interstitium, and mitosis in the tubules as a sign of regenerative activity may be observed in biopsy specimens from a patient with HVS-induced renal injury.
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