Laboratory Investigation

Kidney International (1978) 14, 511–521; doi:10.1038/ki.1978.156

Nonprogressive, histologically mild membranous glomerulonephritis appearing in all evolutionary phases as histologically "early" membranous glomerulonephritis

Tom Törnroth1, Gustav Tallqvist2, Amos Pasternack3 and Ewert Linder4

  1. 1Fourth Department of Medicine, University Central Hospital, Helsinki
  2. 2Departments of Electron Microscopy, and Serology and Bacteriology, University of Helsinki, Helsinki
  3. 3Department of Pathology, Maria Hospital, Helsinki
  4. 4Department of Clinical Sciences, University of Tampere, Finland

Correspondence: Dr T Törnroth, Fourth Department of Medicine, University Central Hospital, Unionink. 33, SF-00170 Helsinki 17, Finland.

Received 18 July 1977; Revised 29 May 1978.

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Abstract

Nonprogressive, histologically mild membranous glomerulonephritis appearing in all evolutonary phases as histologically "early" membranous glomerulonephritis. Seven adult patients with idiopathic nephrotic syndrome and with a glomerular histology considered normal but with ultrastructurally provable membranous glomerulonephritis (MGN) were studied. The glomerular lesions were found to represent all ultrastructural evolutionary phases (A, B, and C) of MGN. In patients with serial biopsies, the membranous lesion seemed to have passed through all of its evolutionary phases towards healing (C) without developing spikes or thickening of the glomerular basement membrane (GBM), i.e., the traditional light microscopic characteristics of MGN. This evolution was associated with a benign clinical course. The membranous lesions were associated with a vacuolization visible in obliquely or tangentially cut segments of the GBM in silver-stained paraffin sections. This alteration seemed to be created by irregularities of the argyrophilic lamina densa of the GBM and not by subepithelial deposits, as suggested previously. All seven patients had a remission of the nephrotic syndrome which appeared to be spontaneous and not drug-induced. The amount of proteinuria correlated with the ultrastructural phase of MGN and with the intensity of immunofluorescent staining. In one patient, the latter became negative.

Glomérulonéphrite membraneuse non progressive, histologiquement modérée apparaissant comme une glomérulonéphrite membraneuse précoce à tous les stades évolutifs. Sept malades adultes atteints de syndrome néphrotique idiopathique dont l'histologie glomérulaire était considérée comme normale, mais pour lesquels l'ultrastructure prouvait une MGN, ont été étudiés. Les lésions glomérulaires ont montré toutes les étapes évolutives ultrastructurales (A, B, et C) de la MGN. Chez les malades pour lesquels des biopsies itératives ont été réalisées, les lésions ont paru être passées par toutes les étapes évolutives jusqu'à la guérison (C) sans qu'apparaissent les "spikes" ou l'épaississement de la membrane basale (GBM), c'est-à-dire les caractéristiques habituelles de la MGN en microscopie photonique. Cette évolution a été parallèle à des signes cliniques mineurs. Les lésions membraneuses ont été associées à une vacuolisation, visible sur les coupes obliques ou tangentielles de segments de GBM imprégnées par l'argent et indues dans la paraffine. Cette modification semble être créée par les irrégularités de la lamina densa argyrophile de GBM et non par les dépôts sous-endothéliaux comme il a été antérieurement suggéré. Les sept malades ont eu une rémission du syndrome néphrotique qui a semblé spontanée et non pas obtenue par un traitement. Le débit de protéinurie était correlé avec l'étape ultrastructurale de MGN et l'intensité des dépôts immunofluorescents. Ces derniers ont disparu ultérieurement chez ces malades.

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