title: Preeclamptic nephropathy -- an endothelial lesion. A morphological study with a review of the literature.
abstract: OBJECTIVE
  We investigated wether an endothelial lesion, postulated in pathogenesis of preeclampsia (PE) in general, is also pathogenetically relevant in the characteristic renal lesions of PE, presenting as special glomerular alterations, designated as "preeclamptic nephropathy".
  
  
  METHODS
  Renal biopsies of 90 women with PE were analyzed by light microscopy (LM), immunohistology (IH) and electron microscopy (EM). Corresponding with clinical data clinicomorphological correlations were performed.
  
  
  RESULTS
  In IH and EM the altered glomeruli demonstrate 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. Close correlations were found between clinical and morphological data. Focal glomerulosclerosis presents a hyperperfusion lesion, developing only facultatively in PE as a result of hyperfiltration.
  
  
  CONCLUSIONS
  In 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-, reparation-, and proliferation-processes, leading to the characteristic glomerular alterations of preeclamptic nephropathy.
authors.affiliation: Institute of Pathology, University of Tübingen, Germany.
authors.forename: H V
authors.initials: HV
authors.lastname: Gärtner
authors.forename: A
authors.initials: A
authors.lastname: Sammoun
authors.forename: M
authors.initials: M
authors.lastname: Wehrmann
authors.forename: T
authors.initials: T
authors.lastname: Grossmann
authors.forename: R
authors.initials: R
authors.lastname: Junghans
authors.forename: C
authors.initials: C
authors.lastname: Weihing
mesh_terms: D000328:Adult; D001706:Biopsy; D004727:Endothelium / Q000737:chemistry / Q000473:pathology; D005169:Factor VIII / Q000032:analysis; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007678:Kidney Glomerulus / Q000473:pathology*; D011225:Pre-Eclampsia / Q000150:complications* / Q000473:pathology; D011247:Pregnancy; D012016:Reference Values
chemical_list: D005169:Factor VIII