Renal morphology in preeclampsia

Abstract

The following account focuses on the renal lesions seen in fresh autopsy material from women with hypertensive disorders of pregnancy, which are compared with those from control groups of gravidas dying from other causes. This survey, based on a previously published text, presents the results only from cases in which the autopsies were performed less than 2 hours after death. Its findings are discussed in relation to recent observations by other investigators. The occurrence of renal lesions in toxemia, as seen in fresh autopsy material, seems to relate to the presence and duration of proteinuria. In toxemia the glomerulus enlarges without an increase in cell number. The most characteristic glomerular lesions include capillary ballooning, where loops fill with swollen foamy endothelial cells and fine collagen fibers. On occasions the ballooned loop pouts into the mouth of the tubules. The visceral epithelium is thick and may contain protein droplets. In contrast to others, we observed fibrin thrombi only rarely and an unaffected basement membrane. Arterioles also seem uninvolved. Many descriptions of altered vessels may relate to elastica beading, a phenomenon present in kidneys of normotensive subjects. The incidence and role of immunoglobulins in the glomeruli of some toxemic subjects remain to be resolved.