Summary
Systematic electron microscopic investigation of glomeruli of 35 patients with renal amyloidosis (grade I–III), among them 26 with the nephrotic syndrome, reveals the following:
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1.
The extent of the area of basement membrane denuded of its epithelial covering is correlated significantly with the reduction of plasma protein concentration at the time of renal biopsy.
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2.
In amyloid free regions of the glomerular capillary loops, the foot processes of the epithelial cells remain intact despite the presence of the nephrotic syndrome. From these findings we conclude that the high glomerular protein losses in amyloidosis occur in areas of the basement membrane which are penetrated by amyloid and denuded of their epithelial covering. With increasing number of these lesions per unit area, the permeability of the capillary network for protein increases to a degree which is significantly correlated with the reduced plasma protein concentration at the time of biopsy.
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References
Bohle, A., Fischbach, H., Wehner, H., Woerz, V., Edel, H. Kluthe, R., Scheler, F.: Minimal changes lesion with nephrotic syndrome and focal glomerular sclerosis. Clin. Nephrol. 2, 52–58 (1974)
Dikman, S., Kahn, Th., Gribetz, D., Churg, J.: Resolution of renal amyloidosis. Am. J. Med. 63, 430–433 (1977)
Farquhar, M.G.: The glomerular filtration barrier — basement membrane or epithelial slits? Kidney Int. 8, 197–211 (1975)
v. Gise, H., Helmchen, U., Christ, H., Mikeler, E., Brüning, L., Walther, Ch., Mackensen, S., Bohle, A.: Correlations between the morphological and clinical findings in a patient recovering from secondary generalised amyloidosis with renal involvement. Virchows Arch. A Path. Anat. and Histol. 379, 119–129 (1978)
Latta, H.: The glomerular capillary wall. J. Ultrastruct. Res. 32, 526 (1970)
Latta, H., Johnston, W.H., Stanley, T.M.: Sialoglycoproteins and filtration barriers in the glomerular capillary wall. J. Ultrastruct. Res. 51, 376 (1975)
Lowenstein, J., Gallo, G.: Remission of the nephrotic syndrome in renal amyloidosis. New Engl. J. Med. 282, 128–132 (1970)
Mackensen, S., Grund, K,-E., Bader, R., Bohle, A.: The Influence of glomerular and interstitial factors on the serum creatinine concentration in renal amyloidosis. Virchows Arch. A Path. Anat. and Histol. 375, 159–168 (1977)
Rumpelt, H.J., Thoenes, W.: Focal and segmental sclerosing glomerulopathy (-nephritis). A pathomorphological study. Virchows Arch. A Path. Anat. and Histol. 302, 265–282 (1974)
Ryan, G.B., Karnovsky, M.J.: An ultrastructural study of the mechanisms of proteinuria in amino-nucleoside nephrosis. Kidney Int. 8, 219 (1975)
Schultz, R.T.: Role of altered vascular permeability in amyloid formation. Am. J. Path. Vol. 86, No. 2, (1977)
Triger, D.R., Joekes, A.M.: Renal amyloidosis. A fourteen-year follow-up. Quart. J. of Med. New Ser. XLII, 15–40 (1973
Watanabe, T., Saniter, T.: Morphological and clinical features of renal amyloidosis. Virchows Arch. A Path. and Histol. 366, 125–135 (1975)
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Gise, H.v., Mikeler, E., Gruber, M. et al. Investigations on the cause of the nephrotic syndrome in renal amyloidosis. Virchows Arch. A Path. Anat. and Histol. 379, 131–141 (1978). https://doi.org/10.1007/BF00432482
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DOI: https://doi.org/10.1007/BF00432482