Summary
The following data was obtained by morphometric and photometric microscopic studies of renal biopsies from 140 patients with idiopathic perimembranous glomerulonephritis, 108 patients with focally sclerosing glomeruloncphritis and 50 patients with membranoproliferative glomerulonephritis and correlation of the results obtained with available clinical data:
-
1.
In all three diseases proteinuria and serum protein concentration show no tendency to stabilization in spite of increasing renal insufficiency.
-
2.
With increasing renal insufficiency the proximal tubular cells become increasingly atrophic.
-
3.
Protein resorption through the proximal tubulus cells becomes increasingly diminished with advancing renal insufficiency.
It is concluded from the present data that proteinuria, which is primarily glomerular caused, is increased by increasingly diminished resorption of proteins in the tubulus system with increasing renal insufficiency. In this way, even under conditions of advanced renal insufficiency with reduced GFR, large amounts of proteins can be excreted and a nephrotic syndrome can persist to a stage of renal insufficiency.
Similar content being viewed by others
References
Barcelo R, Pollak VE (1966) A preliminary immunologic study of urinary proteins: The questionable value of protein clearances in kidney disease. Can Med Assoc J 94:269–275
Boesken WH (1978) Diagnostic significance of SDS-PAH-electrophoresis of urinary proteins: Different forms of proteinuria and their correlation to renal diseases. In: Current problems in clinical biochemistry, Vol 9. Huber, Bern Stuttgart Wien, pp 235–248
Bohle A, Fischbach H, Wehner H, Woerz U, Edel HH, Kluthe R, Scheler F (1974a) Minimal change lesion with nephrotic syndrome and focal glomerular sclerosis. Clin Nephrol 2:52–58
Bohle A, Gärtner H-V, Fischbach H, Bock KD, Edel HH, Frotscher U, Kluthe R, Mönninghoff W, Scheler F (1974b) The morphological and clinical features of membranoproliferative glomeruloncphritis in adults. Virchows Arch [Pathol Anat] 363:213–224
Bohle A, Bader R, Grund KE, Mackensen S, Neunhoeffer J (1977a) Serum creatinine concentration and renal interstitial volume. Virchows Arch [Pathol Anat] 375:87–96
Bohle A, Glomb D, Grund KE, Mackensen S (1977b) Correlation between relative interstitial volume of renal cortex and serum creatinine concentration in minimal changes with nephrotic syndrome and in focal sclerosing glomerulonephritis. Virchows Arch [Pathol Anat] 376:221–232
Bohle A, Grund KE, Mackensen S, Tolon M (1977c) Correlations between renal interstitium and level of serum creatinine. Virchows Arch [Pathol Anat] 373:15–22
Bordeau JE, Carone FA (1974) Protein handling by the renal tubule. Nephron 13:22–34
Gärtner H-V, Watanabe T, Ott V, Adam A, Bohle A, Edel HH, Kluthe R, Renner E, Scheler F, Schmülling RM, Sieberth H-G (1977) Correlations between morphologic and clinical features in idiopathic perimembranous glomerulonephritis. A study on 403 renal biopsies of 367 patients. Curr Top Pathol 65:1–27
Gise H v, Gise V v, Stark B, Bohle A (1981) Nephrotic syndrome and renal insufficiency in association with amyloidosis: A correlation between structure and function. Klin Wochenschr 59:75–82
Kopple JD (1978) Abnormal amino acid and protein metabolism in uremia. Kidney Int 14:340–348
Lubec G, Balzer E (1977) Tubuläre Mitbeteiligung bei glomerulären Erkrankungen der Niere. Wien Klin Wochenschr 89:61–64
Maack TM, Sherman RL (1974) Handling of proteins by the normal kidney. Am J Med 56:71–82
Maack TM (1975) Renal handling of low molecular weight proteins. Am J Med 58:57–64
Maack TM, Johson V, Kau ST, Figuereido J, Sigulem D (1979) Renal filtration, transport and metabolism of lowmolecular proteins: A review. Kindey Int 16:251–270
Mackensen S, Grund KE, Schirmeister J, Bohle A (1979) Impairment of the glomerular filtration rate by glomerular and interstitial factors in membranoproliferative glomerulonephritis with normal serum creatinine concentration. Virchows Arch [Pathol Anat] 382:11–19
Mandal AK (1979) Electron microscopy of the kidney. Plenum Medical Book, New York London
Pollak VE, First MR, Pesce AJ (1974) Value of the sieving coefficient in the interpretation of renal protein clearances. Nephron 13:82–92
Risdon RA, Sloper JC, de Wardener HE (1968) Relationship between renal function and histological changes found in renal biopsy specimens from patients with persistent glomerular nephritis. Lancet II:363–366
Roscoc MH (1961) Proteinuria in the nephrotic syndrome and in hypertensive renal failure. Clin Sci 21:141–150
Schainuck LI, Striker GE, Luther RE, Benditt EP (1970) Structural-functional correlations in renal disease. Hum Pathol 1:631–641
Stolte H, Alt J, Schurek HJ (1979) Experimentelle und klinische Untersuchungen zur Differentialdiagnostik der Proteinurie. Klin Wochenschr 57:1069–1079
Striker GE, Schainuck RE, Luther RE, Benditt EP (1970) Structural-functional correlations in renal disease. Hum Pathol 1:615–630
Strober W, Waldmann TA (1974) The role of the kidney in the metabolism of plasma proteins. Nephron 13:35–66
Waldmann TA, Strober W, Mogielnicki RP (1972) The renal handling of low molecular weight proteins. J Clin Invest 51:2162–2174
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Milewski, C., König, M., v. Gise, H. et al. Clinical and morphological aspects of nephrotic syndrome in perimembranous, focally sclerosing and membrano-proliferative glomerulonephritis. Klin Wochenschr 61, 493–497 (1983). https://doi.org/10.1007/BF01488716
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01488716