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CHAPTER 26
surrounding tissues and also embedded in dense fibrous tissue. The kidneys showed
various degrees of hydro- and pyonephrosis and were also found to be embedded in a
mass of fibrous tissue. Sometimes one of the kidneys was found to be in an extreme
degree of atrophy and very small. These findings were associated in the majority of cases
with amyloidosis of the kidneys and various other organs, but were only occasionally
associated with hepatomegaly.
Tribe (1963) published the results of a more detailed analysis of 150 necropsies of
paraplegics of our Spinal Centre, who died between 1945 and 1962. Twenty-eight
patients died within 2 months after injury; of these, in 16, death was related to their
paraplegia or tetraplegia. Respiratory failure in cervical lesions and pulmonary embolism
in thoracic lesions (T5~Tii) were the most important causes of death. The site of the
venous thrombosis were the leg veins, in one case the pelvic veins. One of the cases died
from paralytic ileus and another from pulmonary oedema due to overtransfusion.
One hundred and twenty-two patients died in later stages following injury, and in 71
death was related to paraplegia. Renal failure was the cause of 27 hypertension and all
but 3 had pyelonephritis. Of 5 fatal cases of cerebral haemorrhage, 4 had hypertension
associated with chronic pyelonephritis. In n of 13 chronic non-traumatic paraplegics
renal failure due to chronic pyelonephritis was also the primary cause of death. Therefore,
of a total of 84 cases where deaths were related to paraplegia 64 (76 per cent) died in
renal failure, the underlying cause being chronic pyelonephritis.
This study was amplified by additional 70 cases, making a total of 220 necropsies,
published by Tribe & Silver in 1969 in a monograph, which was concerned mainly with
renal failure in chronic paraplegia. Of 174 traumatic and non-traumatic chronic cases
related to paraplegia, 117 (97 traumatic and 20 non-traumatic) died from renal failure
due to chronic pyelonephritis, the majority of them associated with amyloidosis.
Sixty of the 174 patients had hypertension (34-8 per cent), the diastolic pressure
varying from 90 to more than 130 mmHg (the latter found in 25 cases). Of the 117 cases
who died from renal failure due to pyelonephritis, 46 (38-5 per cent) had hypertension.
Paroxysmal hypertensive attacks due to autonomic hyperreflexia in lesions above T5
as a result of abnormal action of bladder or other internal organs, are not included in this
series, as there is no proof that these attacks bear any relation to the development of
persistent hypertension.
The age of the majority of hypertensive patients varied between 30 and 40 years.
Cerebro-vascular incidents occurred in 7 cases. Hypertrophy of the heart (heart weight
varying between 420 and 560 g) was found in 27 cases in this series, while in 19 cases the
heart weight varied between 330 and 390 g. Forty-four varying degrees of left ventricular
hypertrophy.
Numerous authors have given reports on the high incidence of renal mortality in
paraplegics and tetraplegics. However, studies on the incidence of hypertension in
chronic pyelonephritis following spinal injuries are still scanty and controversial. Follow
ing Reingold's paper (1960) on the pathology of selected cases of spinal cord injuries at
the 9th Spinal Cord Injury Conference in V.A. Hospital, Long Beach, U.S.A., a discus
sion arose on
the incidence of hypertension in renal disease, associated with
pyelonephrosis. With one exception (Comarr) all other speakers felt that renal hyper-
