Clinical and Experimental Nephrology

, Volume 12, Issue 6, pp 432–439

Analysis of intra-GBM microstructures in a SLE case with glomerulopathy associated with podocytic infolding

Authors

    • The First Department of MedicineHamamatsu University School of Medicine
  • Yoshinori Muranaka
    • Equipment CenterHamamatsu University School of Medicine
  • Masanori Sakakima
    • The First Department of MedicineHamamatsu University School of Medicine
  • Isao Ohta
    • Equipment CenterHamamatsu University School of Medicine
  • Yukitoshi Sakao
    • The First Department of MedicineHamamatsu University School of Medicine
  • Tomoyuki Fujikura
    • The First Department of MedicineHamamatsu University School of Medicine
  • Yuan Sun
    • The First Department of MedicineHamamatsu University School of Medicine
  • Ritsuko Katafuchi
    • Division of NephrologyFukuoka-Higashi Medical Center
  • Kensuke Joh
    • Division of ImmunopathologyClinical Research Center, Chiba-East National Hospital
  • Akira Hishida
    • The First Department of MedicineHamamatsu University School of Medicine
Original Article Special issue Podocytic infolding glomerulopathy: a proposed new disease entity

DOI: 10.1007/s10157-008-0095-9

Cite this article as:
Fujigaki, Y., Muranaka, Y., Sakakima, M. et al. Clin Exp Nephrol (2008) 12: 432. doi:10.1007/s10157-008-0095-9

Abstract

Background

Systemically podocytic infolding into the GBM which causes nonargyrophilic holes in the GBM in association with intra-GBM microstructures has been considered as a new pathological entity. However, its pathomechanisms are largely unknown.

Methods

We analyzed intra-GBM microstructures in an SLE patient with glomerulopathy associated with podocytic infolding by immunoelectron microscopy for vimentin (a marker for both podocyte and endothelium) and C5b-9 and by 3D reconstruction of transmission electron microscopy (TEM) images by computer tomography method.

Results

Immunofluorescent study showed immunoglobulin deposition in a diffuse, capillary pattern; however, electron-dense deposits like stage 3 membranous nephropathy could be found only in some capillary loops by TEM in spite of the systemic existence of podocytic infolding and the intra-GBM microstructures. Three-dimensional reconstructed images of the TEM images revealed that some of the intra-GBM microstructures made connections with the podocyte. The clustered microstructures underneath the podocyte and their surroundings looked as a whole like the degraded part of podocyte in 3D reconstructed images. Immunoelectron microscopy showed that vimentin was positive in most intra-GBM microstructures. C5b-9 was positive along the entire epithelial side of the GBM and in some microstructures, suggesting that the podocytes may be attacked by C5b-9 and that the microstructures may contain C5b-9 bound cellular membranes.

Conclusion

Intra-GBM microstructures may be originated mainly from the podocyte. Podotyte and GBM injuries caused by C5b-9 attack to podocytes might contribute in part to podocytic infolding and intra-GBM microstructures in this case.

Keywords

PodocyteComputer tomographyElectron tomographyTransmission electron microscopyVimentinC5b-9

Copyright information

© Japanese Society of Nephrology 2008