title: A novel approach to the histological diagnosis of pediatric nephrotic syndrome by low vacuum scanning electron microscopy.
abstract: Despite intensive treatment, steroid-resistant nephrotic syndrome (NS) often progresses to endstage renal disease. Therefore, a more accurate and quick histological diagnosis is required to properly treat such patients. The aim of this study was to introduce a novel approach to the histological diagnosis of pediatric NS by low vacuum scanning electron microscopy (LVSEM) and to describe the morphological differences in glomeruli between steroid-sensitive and steroid-resistant NS specimens. The subjects were three patients with steroid-sensitive NS and four patients with steroid-resistant NS. Conventional renal biopsy paraffin sections were stained with platinum-blue (Pt-blue) or periodic acid methenamine silver (PAM) and directly observed under LVSEM at magnifications between ×50 and ×10,000. The Pt-blue-stained sections showed three-dimensional structural alterations in glomerular podocytes and foot processes. PAM-stained sections showed changes in the structure and thickness of the glomerular basement membrane (GBM). Consequently, many round-shaped podocytes and elongated primary foot processes were exclusively recognized in steroid-resistant NS, although irregularities in foot process interdigitation, fusions, effacements, and microvillus transformations were observed in both steroid-sensitive and steroidresistant NS. Irregularities in thickness and the wrinkling of GBMs were clearly detected in steroid-resistant NS. The evaluation by LVSEM is probably useful for the renal histological diagnosis of pediatric NS.
authors.affiliation: Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okada
authors.forename: Sumire
authors.initials: S
authors.lastname: Inaga
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kawaba
authors.forename: Takuya
authors.initials: T
authors.lastname: Hanada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hayashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nakane
authors.forename: Tomonori
authors.initials: T
authors.lastname: Naguro
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kaidoh
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanzaki
mesh_terms: D002648:Child; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008855:Microscopy, Electron, Scanning / Q000379:methods*; D046529:Microscopy, Electron, Transmission; D009404:Nephrotic Syndrome / Q000175:diagnosis*; D014618:Vacuum