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  • Title: Glomerular endotheliosis in normal pregnancy and pre-eclampsia.
    Author: Strevens H, Wide-Swensson D, Hansen A, Horn T, Ingemarsson I, Larsen S, Willner J, Olsen S.
    Journal: BJOG; 2003 Sep; 110(9):831-6. PubMed ID: 14511965.
    Abstract:
    OBJECTIVE: To investigate the proportion of women with findings characteristic for pre-eclampsia, as opposed to renal disease, in a controlled study of hypertensive pregnant women undergoing antepartum renal biopsy. DESIGN: An observational prospective controlled study. SETTING: University Hospital of Lund, Sweden. SAMPLE: Thirty-six previously healthy women with hypertensive disease in pregnancy, consecutively admitted to the antenatal ward at onset of disease during a 20 month period and giving informed consent, as well as 12 voluntary healthy pregnant controls. METHODS: Renal biopsy samples were obtained from all participants and evaluated by light microscopy, electron microscopy and immunofluorescence techniques. MAIN OUTCOME MEASURES: Presence and degree of glomerular endotheliosis. RESULTS: Glomerular endotheliosis was present in all women with pre-eclampsia and gestational hypertension, and in 5 of the 12 controls, although significant differences in the degree of endotheliosis were found between the groups. Clinically undetected renal disease was not diagnosed in any of the women. CONCLUSION: Glomerular endotheliosis was found in women with normal pregnancy as well as in both non-proteinuric and proteinuric hypertension and is consequently not, as earlier believed, pathognomonic for pre-eclampsia. The transition between normal term pregnancy, gestational hypertension and pre-eclampsia appears to be a continuous process, perhaps of increasing adaptation to pregnancy. Pre-eclampsia may be the extreme of the adaptational process, rather than a separate abnormal condition. Clinically undetected renal disease could be a rare cause of hypertension in pregnancy.
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