12 Renal pathology in pre-eclampsia

The renal response to preeclampsia

“…However, an in-depth discussion of these morphologic changes is beyond the scope of this article. Those interested in detailed descriptions and images of the renal pathology, a précis of several disagreements in the literature that include variant immunofluorescent observations and whether or not preeclampsia is a cause of focal glomerular sclerosis, are directed to reports by Sheehan and Lynch 3 and Gaber et al 4,5 A selective summary follows.…”

“…Changes vary with the severity of the lesion, but usually involve most of the capillaries in all glomeruli, and this swelling can be of sufficient magnitude to cause herniation of the tuft into the proximal tubule, a phenomenon termed pouting. 3,4 Although unusual, mesangial interposition and, even more rarely, crescents may be noted. The preeclamptic lesion, however, is most evident on ultrastructure examination, elegantly described in the pioneering work of Spargo et al, 6 and includes extensive swelling and vacuolization, primarily of the endothelial and less often of the mesangial cells, with few if any changes elsewhere.…”

Physiopathologie de la prééclampsie

“…Elles accumulent des lipides et obstruent fréquemment la lumière des capillaires glomérulaires. Ces lésions sont responsables du dysfonctionnement rénal à l'origine de la protéinurie associée à la prééclampsie [63]. Ces lésions constituent une entité très particulière appelée « endothéliose glomérulaire » qui est retrouvées chez 80 % des femmes prééclamptiques.…”

The pathophysiology of pre-eclampsia

“…Even in severe pre-eclampsia, however, GFR does not usually fall by more than approximately 25 % and therefore stays above non-gravid levels. Glomerular capillary thrombosis is not a feature of pre-eclampsia, except in association with placental abruption or puerperal infections when true DIC is triggered [94].…”

“…It seems more likely that the swollen, lipid-filled glomerular endothelial cells assume this morphology because of their unique position in the glomerular filtration barrier. As well as glomerular endothelial cell swelling, fibrin-like subendothelial deposits narrow the capillary lumen and contribute to a reduction of GFR [94]. Even in severe pre-eclampsia, however, GFR does not usually fall by more than approximately 25 % and therefore stays above non-gravid levels.…”