じん透析・移植例の側頭骨病変

Abstract

At autopsy the inner ear of a patient who had received periodic hemodialysis and a cadaver kidney transplantation showed severe edematous changes in both the stria vascularis and the dark cell areas of all semicircular canals. Reissner's membrane was slightly collapsed. The organ of Corti as well as all maculae and cristae showed normal populations of hair cells. This histopathological appearance was similar to the ototoxic effect of loop diuretics. The zonulae occludentes between the marginal cells of the stria vascularis show signs of increased permeability following the administration of loop diuretics. Significant changes in osmolarity have also been shown to modify the permeability of the zonulae occludentes. During hemodialysis an osmotic gradient may occur in the inner ear as well as in the brain, and this osmotic gradient in the inner ear due to hemodialysis may increase the permeability of the zonulae occludentes producing extracellular edema in the stria vascularis and dark cell areas.