Reduced content and abnormal distribution of anionic sites (acid proteoglycans) in the diabetic glomerular basement membrane.

Sulfated proteoglycans (fixed anionic sites) on the glomerular basement membrane (GBM) of kidneys from diabetic and nondiabetic patients have been demonstrated by electron microscopy using polycationic dyes (ruthenium red, polyethyleneimine). These substances were used for immersion fixation of renal biopsy specimens. The thickened GBM of diabetics revealed a reduced proteoglycan content within both the narrowed laminae rarae, where normally particles were seen at 60 nm intervals. Proteinuria was observed in all such cases, but no immunopathological alterations of the basement membranes were seen. With both tracer substances anionic sites were also demonstrated in different segments of the thickened lamina densa in diabetics. In polyethyleneimine-treated biopsies some segments of the membrane showed increased anionic moieties at the junction of the basement membrane and the epithelial and endothelial cell membranes. These are probably acid glycoproteins linked to the cell membrane and the synthesis of these basement membrane components may represent a compensatory mechanism seeking to restore normal permeability.