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Diagnosis: Glomerular Injury of Preeclampsia and Acute Tubular Necrosis
Preeclampsia is a pregnancy-specific disorder that complicates approximately 5% of all pregnancies, making it perhaps the most common glomerular disease in the world. It is characterized by new-onset hypertension and proteinuria, in association with a characteristic glomerular lesion, endotheliosis. “Glomerular endotheliosis” represents a specific variant of thrombotic microangiopathy that is characterized by glomerular endothelial swelling with loss of endothelial fenestrae and occlusion of the capillary lumens. Associated thrombosis is unusual (Stillman IE, Karumanchi SA. The glomerular injury of preeclampsia. J Am Soc Nephrol. 2007;18:2281-4. [PubMed link]).
In glomerular endotheliosis, the glomeruli are enlarged and solidified (“bloodless”), as a result of narrowed or occluded capillary lumens that are the result of swelling of the native endothelial cells and, to a lesser extent, mesangial cells. Glomerular volume is increased and correlates with the severity of the disease. The degree of endotheliosis can vary between glomeruli, although most show at least some involvement. Glomerular cellularity is not significantly increased. It is interesting that the endothelial changes are limited to the glomerular capillaries; arterioles are typically unaffected. Thrombosis by light microscopy is decidedly unusual, although fibrin can be detected by immunofluorescence in glomeruli. In some cases double contours and mesangial interposition can be found in the capillary walls (Stillman IE, Karumanchi SA. The glomerular injury of preeclampsia. J Am Soc Nephrol. 2007;18:2281-4. [PubMed link]).
Although the clinical and morphological renal alterations of preeclampsia usually disappear rapidly, they may take a few weeks. In our case, in addition, acute tubular necrosis was documented, which could have had some relationship with the slower recovery.
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References
- Helmo FR, Lopes AMM, Carneiro ACDM, Campos CG, Silva PB, Dos Reis Monteiro MLG, Rocha LP, Dos Reis MA, Etchebehere RM, Machado JR, Corrêa RRM. Angiogenic and antiangiogenic factors in preeclampsia. Pathol Res Pract. 2018;214(1):7-14. . [PubMed link]
- Prakash J, Ganiger VC. Acute Kidney Injury in Pregnancy-specific Disorders. Indian J Nephrol. 2017;27(4):258-270. [PubMed link]
- Weissgerber TL, Craici IM, Wagner SJ, Grande JP, Garovic VD. Advances in the pathophysiology of preeclampsia and related podocyte injury. Kidney Int. 2014;86(2):445.[PubMed link]
- Henao DE, Saleem MA. Proteinuria in preeclampsia from a podocyte injury perspective. Curr Hypertens Rep. 2013;15(6):600-5.[PubMed link]
- Stillman IE, Karumanchi SA. The glomerular injury of preeclampsia. J Am Soc Nephrol. 2007;18(8):2281-4. [PubMed link]