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Kidney non-tumor

Associated with systemic conditions

Preeclampsia


Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 24 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Disorder of widespread vascular endothelial malfunction and vasospasm, occurs after 20 weeks' gestation (as late as 4-6 weeks postpartum); defined by hypertension and proteinuria (eMedicine, Wikipedia)
● Possible causes of systemic endothelial dysfunction include glomerular capillary endotheliosis, dysregulation of glomerular filtration apparatus, podocyte loss (Clin Nephrol 2012;78:241)
● Causes 50% of pregnancy related hypertension

Clinical features
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● 5-7% of first pregnancies, usually affects women at extremes of reproductive age
● In subsequent pregnancies, associated with multiple births, fetal hydrops
● Called eclampsia if convulsions develop
● May be caused by primary endothelial cell injury causing local intravascular coagulation
● Good prognosis; glomerular changes and blood pressure return to normal within weeks of delivery

Micro description
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● Enlarged, swollen and bloodless glomeruli with capillary lumina obliterated by swollen endothelial cells
● No / mild hypercellularity; may have herniation of capillary tuft into proximal tubule (tufting)
● Rare crescent formation in severe cases; normal afferent arterioles

Micro images
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Various images


Glomerular endotheliosis


Various images (scroll down)

Immunofluorescence
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● Fibrinogen deposits, occasionally IgM

Electron microscopy description
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● Lysosomal-like, single membrane lined vacuoles within cytoplasm of endothelium and mesangial cells
● Some vacuoles contain bland lipids or have myelin-like figures

Electron microscopy images
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Marked endothelial cell swelling and vacuolization and extensive epithelial foot-process effacement


Fig 14.1: swollen endothelial cell with epithelial foot processes intact (A), swollen endothelial and mesangial cells showing prominent vacuolization on capillary lumina


Glomerular capillary

End of Kidney non-tumor > Associated with systemic conditions > Preeclampsia

Ref Updated: 8/7/12


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