Ultrastructural alterations in the sialic acid distribution in minimal change disease and membranous glomerulonephritis.

Kidney biopsy specimens from patients with minimal change disease and membranous glomerulonephritis were embedded in glycolmethacrylate and stained with phosphotungstic acid (PTA) at low pH. Biopsy specimens from patients without proteinuria served as a control. The PTA staining at low pH on glycolmethacrylate sections was used to study the changes in the sialic acid content of the lamina rara externa of the glomerular basement membrane. This method also gives a clear picture of the changes occurring at the epithelial cell coat and these alterations have implications on the distribution of the negative charges. In minimal change disease no alterations could be observed in the sialic acid content of the lamina rara externa. But the luminal epithelial cell coat showed obvious changes in conjunction with extensive foot process widening. In membranous glomerulonephritis with heavy deposits the staining of the lamina rara externa became almost completely negative and the foot process architecture was strongly affected. Obvious defects at the luminal epithelial cell coat, as observed in minimal change disease, were also found regularly. The alterations at the epithelial cell coat are tentatively related to the selective proteinuria reported in minimal change disease. In addition the non-selective proteinuria observed in non-minimal glomerulopathies, may find its origin in the absence of sialic acid molecules from the lamina rara externa.