Renal histopathological and clinical investigation in preeclamptic nephropathy / 中华肾脏病杂志

ABSTRACT

Objective To investigate renal histopathological changes and cli ni cal characteristics in 20 women with preeclamptic nephropathy or gestational pro teinuria.Methods Between 1999 and 2002, 20 women who suffered from preeclampsia or proteinuria during pregnancy underwent postpartum renal biopsies from fifth d ay to third month after delivery. One woman repeated her renal biopsy half year later. Each biopsy specimen was divided into three parts,and processed and stain ed for conventional light microscopy(LM), immunohistology (IH) and electron micr oscopy (EM) examination. The clinicopathological data were studied and women wer e followed up after discharge for a long time. Results Sixteen of 20 women were diagnosed as preeclampsia, whose altered glomeruli demonstrated a typical endoth elial lesion (endotheliosis), and mild to moderate proliferation of mesangial ce lls. IH revealed either negative or mild IgG、IgM and C3 deposits. Focal glomeru losclerosis (FGS) was observed in one of 16 cases, whose microproteinuria (0 49 g/24 h) lasted for more than one year, meanwhile the proteinuria of other 15 wo men disappeared completely within 3～6 months after delivery. Besides, one was I gA nephropathy (IgAN) complicated preeclamptic nephropathy, whose proteinuria de creased obviously after delivery, but remained microhematuria, and endothelial l esion disappeared in repeat biopsy after half year. One was IgAN and received a treatment of adrenocorticosteroid and immunosupressive agents because of macropr oteinuria. One was mild mesangial proliferative glomerulonephritis presenting co nstant microhematuria and microproteinuria. One was typeⅠmembranous nephropathy , whose proteinuria decreased remarkably after delivery as well. Conclusions Ren al histopathological changes of preeclampsis are typical endothelial lesion, and often recover completely within 6 months after delivery. Recovery may be delaye d in the case of FGS accompanied. Pregnancy may aggravate primary renal damage w hich will be improved after delivery. Postpartum renal biopsy is safe and benefi cial to early diagnosis, treatment and prognosis.