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(Case provided courtesy of Dr. Arthur H. Cohen, Cedars Sinai Medical Center, UCLA, Los Angeles, CA)

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman
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Fig 1. The renal lesions are not substantially different in pre-eclampsia than in eclampsia. The glomeruli are the primary target, and the severity of morphologic alterations parallels the severity of clinical disease. The glomeruli are diffusely slightly enlarged and swollen and appear bloodless. The glomerular capillary lumina are narrowed or even obstructed because of marked mesangial and endothelial cell swelling and hypertrophy, so-called glomerular capillary endotheliosis. Mesangial interposition, as illustrated here, may be more prominent in more severe disease and in the healing stage. (Jones' silver stain, X400).
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Fig 2. The classic lesion of pre-eclampsia/eclampsia, endotheliosis, is illustrated in this glomerulus. There is also evident glomerular visceral epithelial cell swelling. Occasionally glomerular visceral epithelial cells may contain hyaline droplets. Segmental double contours are also apparent, due to the interposition of mesangial cell cytoplasm processes. Mesangial and glomerular endothelial foam cells are not present in this biopsy, but may be present as part of the endotheliosis lesion postpartum. The presence of foam cells thus correlates with the timing of the biopsy. (Jones' silver stain, X400).
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Fig 3. The electron microscopic appearance of pre-eclampsia/eclampsia illustrates the swelling of glomerular endothelial cells with vacuolization and lipid material. Not illustrated here, myelin figures and dense bodies and amorphous subendothelial deposits related to fibrin/fibrinogen-related breakdown products may also be found in the mesangium and subendothelium. Visceral epithelial cells show vacuoles and lipid droplets. There may also be increased lucency of the lamina rara interna and interposition, not illustrated in this capillary loop. (Transmission electron microscopy, X12000).

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232.
Am J Kidney Dis 38(2):E4, 2001 (available
 Copyright 2001 by the National Kidney Foundation, Inc.

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