FSGS-like lesions in pre-eclampsia.

Renal-biopsy specimens taken from pre-eclamptic patients are associated sometimes with focal-segmental glomerular sclerotic lesions (FSGS-like lesions) that closely resemble those of primary focal-segmental glomerulosclerosis. We studied a series of 60 sections from each of 19 cases of "pure" pre-eclampsia by light microscopy. Group I comprised 13 patients with FSGS-like lesions in their glomeruli, group II comprised 6 patients without such lesions. FSGS-like lesions were observed in 20.7 +/- 4.6% of glomeruli in group I. Epithelial droplets were observed in 12 of 13 cases in group I, but only one of 6 cases in group II. The incidence of granulated glomerular epithelial cells was significantly higher in group I (p less than 0.0005). The double contour of the basement membrane was more severe in group I than in group II (p less than 0.03). The percentage of glomeruli with FSGS and the number of weeks during which proteinuria of greater than or equal to g/day continued after delivery were positively correlated (r = 0.76, p less than 0.0002). We also found a significant positive correlation between the percentage of glomeruli with FSGS and the amount of proteinuria at delivery and biopsy (r = 0.66, p less than 0.003; r = 0.51, p less than 0.03). However, proteinuria disappeared in all patients. Three of them had successful second pregnancies. We consider that FSGS-like lesions can occur during pregnancy in "pure" pre-eclamptic patients but the lesions may not be progressive. We also suggest that proteinuria and epithelial cell change may be closely related with such lesions.

[A renal biopsy study in pre-eclampsia: clinical-pathological correlations in 20 cases].

Twenty cases of pre-eclamptic toxemia were examined clinicopathologically. Twelve primipara and 6 multipara underwent renal biopsy at 1-24 (3.5 +/- 5.4, mean +/- SD) weeks after delivery. Specimens were examined by light and electron microscopy and immunofluorescence. Their mean blood pressure at delivery was 177.0 +/- 19.4/116.3 +/- 10.2 mmHg, proteinuria was 9.5 +/- 8.4 g/day. Follow-up period was 23.0 +/- 19.3 months after delivery. The severity of double contour of the glomerular basement membrane and mesangial interposition were correlated with the amount of proteinuria at biopsy (r = 0.40, p less than 0.05, r = 0.51, p less than 0.05, respectively). Proteinuria disappeared in all cases after delivery. The length of the hypertensive period after delivery correlated with the severity of glomerular lesions (r = 0.63, p less than 0.05), but did not correlated with the severity of vascular lesions. All patients became normotensive within three months after delivery. No patients showed microhematuria during pregnancy or after delivery.