The structural changes that occur during 72-hour hypothermic storage of previously uninjured kidneys have been described by Mackay who showed how there was progressive vacuolation of the cytoplasm of the cells which particularly affected the proximal tubules. On electron microscopy the mitochondria were seen to become swollen with early separation of the internal cristal membranes and later loss of all internal structure. Lysosomal integrity was well preserved until late, and the destruction of the cell did not appear to be caused by lytic enzymes because there was no more injury immediately adjacent to the lysosomes than in the rest of the cell.
Woods and Liu – when describing successful 5 and 7 day kidney storage - described the light microscopic changes seen at the end of perfusion and at post mortem, but found few gross abnormalities apart from some infiltration with lymphocytes and occasional tubular atrophy.
The changes during short perfusions of human kidneys prior to reimplantation have been described by Hill who also performed biopsies 1 hour after reimplantation. On electron microscopy Hill found endothelial damage which correlated with the severity of the fibrin deposition after reimplantation. The changes that Hill saw in the glomeruli on light microscopy were occasional fibrin thrombi and infiltration with polymorphs. Hill suspected that these changes were an immunologically induced lesion, but found that there was no correlation between the severity of the histological lesion and the presence or absence of immunoglobulin deposits.
There are several reports of the analysis of urine produced by kidneys during perfusion storage. Kastagir analysed urine produced during 24-hour perfusion and found it to be an ultrafiltrate of the perfusate, Scott found a trace of protein in the urine during 24-hour storage, and Pederson found only a trace of protein after 36 hours perfusion storage. Pederson mentioned that he had found heavy proteinuria during earlier experiments. Woods noted protein casts in the tubules of viable kidneys after 5 day storage, but he did not analyse the urine produced during perfusion. In Cohen's study there was a progressive increase in urinary protein concentration during 8 day preservation until the protein content of the urine equalled that of the perfusate. This may have been related to the swelling of the glomerular basement membranes and the progressive fusion of epithelial cell foot processes that was also observed during the same period of perfusion storage.