Kincaid-Smith P
Department of Medicine, University of Melbourne, Victoria, Australia.
Am J Kidney Dis. 1991 Feb;17(2):144-8. doi: 10.1016/s0272-6386(12)81119-x.
Controversy has existed about the relative contributions of subendothelial "fibrinoid" deposits and endothelial cell swelling to the thickened glomerular capillary wall and reduced lumen in preeclampsia. A morphometric analysis of the ultrastructural changes in the glomerulus in preeclampsia showed that subendothelial fibrinoid deposits were a significant feature of biopsies during pregnancy, but were absent in many biopsies in the postpartum period. These deposits disappear progressively in the first week after delivery. Capillary wall changes with reduplication of glomerular capillary walls and mesangial interposition are another prominent feature of preeclampsia. These changes resolve gradually and may present for as long as 18 months. Foam cells in glomeruli are rarely found in biopsies during pregnancy, but appear during resorption of the subendothelial deposits in the postpartum period. Electron-dense droplets in glomerular epithelial cells are a characteristic feature of preeclampsia. Immunogold labeling demonstrates that they contain albumen, immunoglobulins, fibrinogen, and complement. Fibrinogen is usually present in an inner electron-dense core in a droplet. IgM is usually in a relatively translucent outer part of the droplet. Other proteins are diffusely distributed. Segmental hyalinosis is a change that closely resembles the changes of preeclampsia, and segmental lesions may appear during preeclampsia and disappear after pregnancy.
关于子痫前期肾小球毛细血管壁增厚和管腔狭窄，内皮下“纤维蛋白样”沉积物和内皮细胞肿胀的相对作用一直存在争议。一项对子痫前期肾小球超微结构变化的形态计量学分析表明，内皮下纤维蛋白样沉积物是孕期活检的一个显著特征，但在产后许多活检中并不存在。这些沉积物在分娩后的第一周逐渐消失。肾小球毛细血管壁重复和系膜插入导致的毛细血管壁变化是子痫前期的另一个突出特征。这些变化会逐渐消退，可能会持续长达18个月。孕期活检中很少在肾小球中发现泡沫细胞，但在产后内皮下沉积物吸收过程中会出现。肾小球上皮细胞中的电子致密滴是子痫前期的一个特征性表现。免疫金标记显示它们含有白蛋白、免疫球蛋白、纤维蛋白原和补体。纤维蛋白原通常存在于滴内的一个内部电子致密核心中。IgM通常位于滴的相对半透明的外部。其他蛋白质则呈弥散分布。节段性玻璃样变是一种与子痫前期变化非常相似的改变，节段性病变可能在子痫前期出现，并在产后消失。
