PREECLAMPTIC NEPHROPATHY - AN ENDOTHELIAL LESION - A MORPHOLOGICAL-STUDY WITH A REVIEW OF THE LITERATURE

Objective: We investigated wether an endothelial lesion, postulated in pathogenesis of preeclampsia (PE) in general, is also pathogeneticall y relevant in the characteristic renal lesions of PE, presenting as sp ecial glomerular alterations, designated as ''preeclamptic nephropathy ''. Study Design: Renal biopsies of 90 women with PE were analyzed by light microscopy (LM), immunohistology (IH) and electron microscopy (E M). Corresponding with clinical data clinicomorphological correlations were performed. Results: In IH and EM the altered glomeruli demonstra te an endothelial lesion. Consecutive morphological reactions could be revealed by EM, allowing a subdivision in different stages of disease . The late stage indicates the reversibility of these renal lesions. C lose correlations were found between clinical and morphological data. Focal glomerulosclerosis presents a hyperperfusion lesion, developing only facultatively in PE as a result of hyperfiltration. Conclusion: I n preeclamptic nephropathy the first morphological substrate of renal changes with the key to pathogenesis presents itself as an endothelial lesion. This results in a disturbance of glomerular basement membrane permeability and in an imbalance of different mediator systems, with dominance of vasoconstrictive reactions but also coagulative-, reparat ion-, and proliferation-processes, leading to the characteristic glome rular alterations of preeclamptic nephropathy. (C) 1998 Elsevier Scien ce Ireland Ltd.