ELECTRONMICROSCOPIC STUDIES OF REVERSIBLE GLOMERULAR LESIONS IN THE ADULT NEPHROTIC SYNDROME

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Abstract
Clinical, laboratory, and serial histologic and electronmicroscopic observations were made on an adult with the nephrotic syndrome. He was treated with prednisone, diuresed, and renal function returned to normal. The 24-hour excretion of protein in the urine decreased from 15 g to 1-2 g and later to 0 g. Eighteen months after the start of his illness there is no evidence of renal disease. Histologic studies revealed damage to the tubules in the 1st biopsy made before treatment was started, but only minor glomerular abnormalities. The glomeruli and tubules appeared normal in the 2d biopsy taken after diuresis, and in the 3d taken 8 months later. Electronmicroscopic studies of the glomeruli revealed normal basement membrane and endothelial cells. The epithelial cells were abnormal in the 1st biopsy, almost normal in the 2d, and completely normal in the 3d. The abnormalities were: replacement of the pedicels by an abnormal layer of epithelial cytoplasm, vacuolation of perinuclear and trabecular cytoplasm, and the presence in the capsular space of large numbers of osmiophilic "bodies." These were considered to represent the glomerular changes in lipoid nephrosis. The relationship of lipoid nephrosis to membranous glomerulonephritis was discussed.