FSGS-like lesions in pre-eclampsia.

Renal-biopsy specimens taken from pre-eclamptic patients are associated sometimes with focal-segmental glomerular sclerotic lesions (FSGS-like lesions) that closely resemble those of primary focal-segmental glomerulosclerosis. We studied a series of 60 sections from each of 19 cases of "pure" pre-eclampsia by light microscopy. Group I comprised 13 patients with FSGS-like lesions in their glomeruli, group II comprised 6 patients without such lesions. FSGS-like lesions were observed in 20.7 +/- 4.6% of glomeruli in group I. Epithelial droplets were observed in 12 of 13 cases in group I, but only one of 6 cases in group II. The incidence of granulated glomerular epithelial cells was significantly higher in group I (p less than 0.0005). The double contour of the basement membrane was more severe in group I than in group II (p less than 0.03). The percentage of glomeruli with FSGS and the number of weeks during which proteinuria of greater than or equal to g/day continued after delivery were positively correlated (r = 0.76, p less than 0.0002). We also found a significant positive correlation between the percentage of glomeruli with FSGS and the amount of proteinuria at delivery and biopsy (r = 0.66, p less than 0.003; r = 0.51, p less than 0.03). However, proteinuria disappeared in all patients. Three of them had successful second pregnancies. We consider that FSGS-like lesions can occur during pregnancy in "pure" pre-eclamptic patients but the lesions may not be progressive. We also suggest that proteinuria and epithelial cell change may be closely related with such lesions.