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The Glomerular Injury of Preeclampsia

Isaac E. Stillman^*, and S. Ananth Karumanchi^,

^* Department of Pathology and Renal Division, Department of Medicine, and Renal, Vascular and Molecular Medicine Divisions, Departments of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts

Correspondence: Dr. Isaac E. Stillman, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. Phone: 617-667-5959; Fax: 617-667-7120; E-mail: istillma{at}bidmc.harvard.edu

Preeclampsia is a pregnancy-specific disorder that complicates approximately 5% of all pregnancies, making it perhaps the most common glomerular disease in the world. It is characterized by new-onset hypertension and proteinuria, in association with a characteristic glomerular lesion, endotheliosis. "Glomerular endotheliosis" represents a specific variant of thrombotic microangiopathy that is characterized by glomerular endothelial swelling with loss of endothelial fenestrae and occlusion of the capillary lumens. Associated thrombosis is unusual. Recent evidence suggests that this unusual glomerular lesion is mediated by a soluble vascular endothelial growth factor receptor that deprives glomerular endothelial cells of the vascular endothelial growth factor that they require, leading to cellular injury and disruption of the filtration apparatus with subsequent proteinuria. This review summarizes the histologic changes and the pathogenesis of the glomerular lesions of preeclampsia.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673