Value of Routine Electron Microscopy in the Differential Diagnosis of the Nephrotic Syndrome

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Abstract
Routine electron microscopic examination of renal biopsies was performed in 37 nephrotic patients with primary glomerular lesions. These cases were classified according to the following pathological patterns: lipoid nephrosis (‘minimal change’, 17 cases), membranous nephropathy (12 cases), focal glomerular sclerosis (1 case), proliferative glomerulonephritis (5 cases), chronic glomerulonephritis (1 case), and ‘unclassified glomerulonephritis’ (1 case). 23 of the presented cases had been diagnosed as lipoid nephrosis by light microscopy. The electron microscopic study confirmed this diagnosis in only 17 cases, demonstrating an early stage of membranous nephropathy in four cases, focal glomerular sclerosis in one case and ‘unclassified glomerulonephritis’ in one case. Brief clinical data of the patients are presented and related to the morphologic findings. The various glomerular lesions causing a nephrotic syndrome in which electron microscopy may aid in attaining a correct diagnosis are summarized and the therapeutic and prognostic importance of accurate diagnosis is stressed.

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