Bonsib S M
Am J Pathol. 1985 Jun;119(3):357-60.
Glomerulonephritides which develop necrotizing and crescentic lesions usually have glomerular basement membrane (GBM) disruptions when carefully examined by light microscopy or transmission electron microscopy. Despite numerous excellent and detailed ultrastructural investigations of GBM discontinuities, a complete appreciation of their actual number, appearance, and distribution within a glomerulus has been difficult to achieve by reconstruction of two-dimensional light or transmission electron microscopic images. Selective removal of podocytes by a sequence of lytic and solubilization procedures has been developed which exposes any structural alteration of the GBM to direct examination by scanning electron microscopy. A case of idiopathic, immune-complex-negative, focal-segmental necrotizing glomerulonephritis has been studied by this technique, permitting three-dimensional visualization of the GBM defects which result in free communication between the vascular and urinary spaces. These disruptions were distinctive by their frequency within an affected lobule, variable size, and sharply demarcated edges. Application of this technique to human renal biopsies is capable of enhancing our understanding of the morphologic alterations occurring in human glomerulonephritis.
通常，发展为坏死性和新月体性病变的肾小球肾炎，经光学显微镜或透射电子显微镜仔细检查时，肾小球基底膜（GBM）会出现中断。尽管对GBM连续性进行了大量出色且详细的超微结构研究，但通过二维光学或透射电子显微镜图像重建，很难全面了解其在肾小球内的实际数量、外观和分布。已开发出一系列溶解和增溶程序来选择性去除足细胞，从而使GBM的任何结构改变都能通过扫描电子显微镜直接检查。通过该技术对一例特发性、免疫复合物阴性、局灶节段性坏死性肾小球肾炎病例进行了研究，从而能够三维可视化导致血管腔和尿腔自由连通的GBM缺陷。这些中断在受影响的小叶内的频率、大小各异以及边缘清晰可辨，具有独特性。将该技术应用于人类肾活检，能够增进我们对人类肾小球肾炎中发生的形态学改变的理解。
