Lee H S, Kim T S
Department of Pathology, Seoul National University College of Medicine, Korea.
Clin Nephrol. 1995 Jul;44(1):14-21.
Focal segmental glomerulosclerosis (FSGS) is observed in severe or atypical preeclamptic patients biopsied postpartum. To further define the structural characteristics that might be related to atypical clinical manifestations in this disorder, we analyzed the postpartum renal biopsies of eight preeclamptic patients with FSGS by morphometry and studied the structural-functional relationships. For comparison, three postpartum biopsies with primary FSGS and eight nonpregnant subjects with primary FSGS were also studied. Mesangial volume fraction was increased in the preeclamptic FSGS group being 2 times that of the pregnant or nonpregnant primary FSGS group. Mean surface density of peripheral glomerular basement membrane (PGBM) per glomerulus was markedly decreased in the preeclampsia group being 1/3 that for the pregnant or nonpregnant primary FSGS group. Volume density of cortical interstitium in the preeclamptic FSGS was smaller than that of the primary FSGS group. In preeclamptic FSGS, mesangial volume fraction correlated inversely with PGBM surface area (r = -0.84; p < 0.01) and with creatinine clearance (Ccr) (r = -0.63; p < 0.05). PGBM surface area per glomerulus in preeclamptic FSGS correlated with Ccr (r = +0.63; p < 0.05). Mean volume density of cortical interstitium was not related to Ccr nor with the percentage of glomeruli with FSGS in preeclamptic FSGS. These results suggest that decreased glomerular filtration function in atypical preeclampsia is linked to decreased PGBM surface area, that results from mesangial expansion and particularly from mesangial interposition.
在产后接受活检的重度或非典型先兆子痫患者中观察到局灶节段性肾小球硬化（FSGS）。为了进一步明确可能与该疾病非典型临床表现相关的结构特征，我们通过形态计量学分析了8例患有FSGS的先兆子痫患者的产后肾活检组织，并研究了其结构与功能的关系。作为对照，我们还研究了3例原发性FSGS产后活检组织以及8例非妊娠原发性FSGS受试者。先兆子痫合并FSGS组的系膜体积分数增加，是妊娠或非妊娠原发性FSGS组的2倍。先兆子痫组每个肾小球外周肾小球基底膜（PGBM）的平均表面密度显著降低，仅为妊娠或非妊娠原发性FSGS组的1/3。先兆子痫合并FSGS组皮质间质的体积密度小于原发性FSGS组。在先兆子痫合并FSGS中，系膜体积分数与PGBM表面积呈负相关（r = -0.84；p < 0.01），与肌酐清除率（Ccr）呈负相关（r = -0.63；p < 0.05）。先兆子痫合并FSGS中每个肾小球的PGBM表面积与Ccr相关（r = +0.63；p < 0.05）。先兆子痫合并FSGS中皮质间质的平均体积密度与Ccr以及FSGS肾小球的百分比均无关。这些结果表明，非典型先兆子痫中肾小球滤过功能的降低与PGBM表面积的减少有关，而这是由系膜扩张尤其是系膜插入导致的。
