Alcorn D, Ryan G B
Pathology. 1981 Jan;13(1):37-50. doi: 10.3109/00313028109086828.
It is widely believed that polyanionic plasma proteins, such as albumin, are normally prevented from penetrating the glomerular capillary wall by the presence of intrinsic fixed negative charges in the wall. There is also strong support for the corollary that proteinuria occurs in glomerular disease as a result of loss of such charges. Morphologic studies using cationic 'stains' have indicated that anionic groups can be detected in normal glomeruli and that, in proteinuric states, there is an apparent reduction in such staining. Because most of the latter claims are based largely upon light microscopic studies, critical reassessment at the electron microscopic level is necessary, particularly using the recently developed technique of in situ drip-fixation of superficial glomeruli during good blood flow. In normal rats, this technique results in heavy cationic colloidal iron staining of podocytic epithelial surfaces but little or no staining in the basement membrane or within endothelial fenestrae. In two experimental proteinuric models, rat nephrotoxic nephritis and aminonucleoside nephrosis, there was no loss of colloidal iron staining on podocytic epithelial surfaces at any stage. There was, however, a striking alteration in glomerular architecture in each model, particularly affecting podocytic epithelium. Thus, there was extensive replacement of foot processes by flattened expanses of epithelial cytoplasm, associated with scattered focal gaps in the epithelial covering of the basement membrane. It therefore appears that the reduction of glomerular polyanion seen by light microscopy in glomerular disease results simply from a decrease in visceral epithelial surface area rather than a loss of intrinsic polyanion from the filtering portion of the glomerular capillary wall.
人们普遍认为,多阴离子血浆蛋白,如白蛋白,通常会因肾小球毛细血管壁内固有的固定负电荷而无法穿透该壁。对于蛋白尿在肾小球疾病中是由于此类电荷丧失所致这一推论,也有有力支持。使用阳离子“染料”的形态学研究表明,在正常肾小球中可检测到阴离子基团,而在蛋白尿状态下,此类染色明显减少。由于大多数后一种说法主要基于光学显微镜研究,因此有必要在电子显微镜水平进行严格的重新评估,特别是使用最近开发的在良好血流状态下对浅表肾小球进行原位滴注固定的技术。在正常大鼠中,该技术导致足细胞上皮表面有大量阳离子胶体铁染色,但在基底膜或内皮窗孔内几乎没有或没有染色。在两种实验性蛋白尿模型,即大鼠肾毒性肾炎和氨基核苷肾病中,在任何阶段足细胞上皮表面的胶体铁染色都没有丧失。然而,每个模型中的肾小球结构都有显著改变,尤其影响足细胞上皮。因此,足突被扁平的上皮细胞质大片取代,同时基底膜上皮覆盖层出现散在的局灶性间隙。所以,在肾小球疾病中通过光学显微镜观察到的肾小球多阴离子减少,似乎仅仅是由于脏层上皮表面积减少,而不是肾小球毛细血管壁滤过部分固有多阴离子的丧失。