PATHOLOGY 



Similar changes were produced in rats with low). The basal folds of the cell membranes 



rabbit anti-kidney serum (Ehrich and Piel, had almost disappeared. Similar changes, but 



1953) and in rabbits by intravenous injec- less prominent, were also present in the loops 



tion of saccharated iron oxide (Ellis, 1959). of Henle and the distal convoluted tubules. 



A nephrotic syndrome has occasionally Most authors consider the swelling of the 



developed in children during treatment with epithelial cells with loss of foot process or- 



trimethadione "Tridione". Electron micro- ganization to be the first observable lesion in 



scopic investigation of biopsy material has these diseases. Experimental observations 



shown glomerular lesions very similar to indicate that there is a causal relation be- 



those observed in aminonucleoside nephrosis tween proteinuria and epithelial cell changes. 



(Gribetz et al., 1959). Several authors have discussed the possibil- 



Lipide Nephrosis and Familial Nephro- ity that the primary lesion (swelling) is in the 

 sis. A great number of reports on electron basement membrane with an increased per- 

 microscopic studies of renal changes in pa- meability and leakage of proteins. The pres- 

 tients with lipide nephrosis or familial ne- ence of proteins in considerable amounts in 

 phrosis has been published recently (Ver- the filtrate would give rise to the changes of 

 nier et al., 1956, 1958, 1959; Farquhar et al., the epithelial cells. (Vernier et al., 1958a, b; 

 1957a, b, c; Piel and Williams, 1957; Folli et Movat and McGregor, 1959a, b; Sitte, 1959.) 

 al., 1957, 1958, 1959; Dalgaard, 1958a; Spiro, It has been shown by several authors that 

 1958, 1959a, b; Fiaschi et al., 1959; Putois, the epithelial cell changes may be reversible. 

 1959). The glomerular changes were very They disappear in cases which respond favor- 

 similar to those observed in experimental ably to hormone treatment simultaneously 

 nephrosis. They were first localized to the with the proteinuria. (Piel and WilUams, 

 capillary epithelial cells. The organization of 1957; Dalgaard, 1958a, b; Folli, 1958; Pu- 

 the foot processes was destroyed. The vari- tois, 1959; McDonald et al., 1959; Vernier 

 ous epithelial cell processes on the outside of et al., 1958a, 1959b.) 



the capillary wall were fused so that the wall Membranous Glomerulonephritis. In 



was covered by a practically continuous layer cases with a long standing nephrotic syn- 



of epithelial cells. These cells also showed an drome and light microscope changes 



increased number of large vacuoles and can- described as chronic membranous glomeru- 



aliculi belonging to the endoplasmic reticu- lonephritis there is a more marked thicken- 



lum. These findings were obsei'ved in all ing of the glomerular capillary basement 



cases regardless of the clinical phase of the membranes (PoWak etal., 1958; Fiaschi e^ a/., 



disease. In more severe cases of long duration 1959). There is also a swelling and prolifer- 



irregular thickenings w^ere noted in the base- ation of the endothelial cells comparable to 



ment membranes alternating with empty- what is seen in acute glomerulonephritis. In 



appearing spaces. The endothelial cells were some cases ("mixed type") the epithelial 



also swollen but contrary to what was ob- cells may also be destroyed or increased in 



served in glomerulonephritis, this occurred number as in proliferative glomerulonephri- 



only in late stages of the disease. tis. 



In the epithelial cells of the proximal con- Experimentally Produced Renal Am- 

 voluted tubules there was a focal loss of the yloidosis. Miller and Bohle (1956) have 

 brush border. Many large vacuoles were ob- produced amyloidosis in mice with sodium- 

 served in the apical part of the cells. The caseinate and ACTH. They were able to 

 mitochondria were fragmented or swollen demonstrate a diffuse thickening and nodular 

 with loss of the inner structure as observed protrusions of the glomerular capillary base- 

 during increased protein resorption (see be- ment membranes. The nodules bulged into 



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