GLOMERULAR HYPERTROPHY IN RELAPSING MINIMAL CHANGE NEPHROPATHY

Clinicopathological and morphometric analysis of glomerular hypertroph y was conducted using biopsies from 89 patients with minimal change ne phrotic syndrome (MCNS). Of the 89 patients, in 69 with complete remis sion and in 20 with one or more relapses, various clinical and morphom etric parameters were compared to 15 normal controls. Proteinuria was more severe and serum creatinine (Cr) concentration significantly high er in patients with relapse of proteinuria. The morphometric analysis showed that the sizes of (1) glomerular tufts and (2) glomerular capil laries were significantly larger in patients in the relapse group than in the remission or control groups, but no difference in the size of Bowman's capsule was found between the two MCNS subgroups. The intertu bular capillaries were narrower in patients who failed to reach prompt complete remission. A negative correlation between intra- and extragl omerular capillary size was evident (r = -0.83, p < 0.001). A definiti ve correlation was detected between the circumference of glomerular ca pillary loops and the degree of proteinuria (r = 0.89, p < 0.001). The mean tubulocapillary diffusion distance was significantly longer in b iopsies of the patients in relapse and showed a close significant corr elation with serum Cr level (r = -0.87, p < 0.001) and intertubular ca pillary size (r = -0.87, p < 0.001). These data suggest that extra- an d intraglomerular hemodynamic alterations in MCNS lead to glomerular h ypertrophy, and dilatation of the glomerular capillary loop plays a ke y role in the relapse of MCNS.