Biopsy Material from Patients with Renal Diseases 



257 



Case Report. — A 32-yeai-old man. In March 1951 

 headache, proteinuria and haematuria. After a few days 

 desquamation of the epidermis on hands and feet was 

 observed. No rash. The blood pressure was normal. The 

 diagnosis was scarlatina with acute, hacmorrhagic glo- 

 merulonephritis, in January and June 1952 recurrent 

 attacks of proteinuria and haematuria with slight eleva- 

 tion of the blood pressure in connection with intlam- 

 mation of the throat. Endogenous creatinine clearance 

 was 52-118/ml per minute. In January 1953 a new 

 attack developed, associated with diarrhoea. Repeated 

 controls afterwards have shown a constant but very slight 

 proteinuria and an intermittent haematuria. The highest 

 systolic blood pressure recorded was 145 mm Hg. Hx- 

 ogenous creatinine clearance was 136 ml per minute and 

 PAH clearance was 560 ml per minute in April 1956. 



Renal biopsy was performed in April and June 1956 

 by the method of Kark and Muerhcke (2) with a 

 modified Vim-Silberman needle. The specimen was divi- 

 ded in half. One part was fixed in 10 per cent formalin, 

 embedded in paraffin and sectioned and stained b> 

 the routine methods of this laboratory. The other half 

 was fixed in 1 per cent osmium tetroxide solution, 

 dehydrated and embedded in methacrylates according 

 to the method described by Palade (4), Newman, 

 Borysko and Swerdlow (3) and Rhodin (5). The blocks 

 were sectioned on a Sjostrand ultramicrotomeand studied 

 in a RCA electron microscope model 2d. 



Results. — In the light microscope no changes could 

 be observed in the renal glomeruli. This does not 

 exclude the presence of changes in the glomeruli in 

 other parts of the kidneys or that there are changes, 

 which are so slight that they are not observable with 

 this technique. In our opinion the clinical signs are 

 so significant, however, that the diagnosis may 

 anyhow be regarded as very probable. 



The electron microscope investigation showed the 

 presence of red blood cells in the space between the 

 capillaries, which is most probably the source of the 

 haematuria. Furthermore, changes were observed 

 both in the endothelial and epithelial cells of the 

 capillary walls. 



Fig. 1. Part of a capillary lumen in a glomcruUis with 

 "spherical bodies" in the lumen. Biopsy material from 

 patient suffering from mild subacute glomerulonephritis. 

 Magnification x 19,000. 



1 7 — 568204 Electron Microscopy 



Fig. 2. Part of endothelial cell in a gioincrulu^. Same case 

 as fig. 1. Large vesicle bordered by a double membrane at 

 A. Magnification < 30,000. 



The endothelial cells: Fig. 1 shows part of a capil- 

 lary lumen in a glomerulus. In the lumen a number 

 of "spherical bodies"" are observed. They have a 

 diameter of about 1 micron and are bordered by a 

 single membrane. Inside the bodies small rounded 

 or elongated organelles may be discerned. They are 

 bordered by a very delicate membrane and may be 

 regarded as very small vesicles. Similar organelles 

 may be observed in the cytoplasm of the endothelial 

 cells and also in many other kinds of cells outside 

 the renal glomeruli. The "spherical bodies"" cannot 

 be regarded as pathological phenomena. Similar 

 bodies have been observed by the present authors in 

 normal animals (rats, rabbits and dogs). The number 

 and size of the "spherical bodies"" is marked 1\ in- 

 creased in the glomeruli of this patient as compared 

 to what has been observed in animals, however. In 

 the laboratory animals the small organelles inside 

 the bodies are very few or entirely lacking, whereas 

 they are numerous and very distinct in our patient. 

 Thus it is possible that the process of formation of 

 "spherical bodies"" is increased in the diseased kid- 

 ney. 



The function and the exact nature of these "spher- 

 ical bodies"" is not known. In our opinion they are 

 formed inside the endothelial cells and are parts of 

 the cell protoplasm, v\hich are ejected into the blood 

 stream. Some observations both from this patient 

 and from animals support this assumption. 



Fig. 2 shows a part of an endothelial cell in the 

 glomeruli of our patient. Inside the c> toplasm a very 

 large vesicle (A) is observed. It is bordered by a 

 double membrane. There are no cell organelles in- 

 side it. 



Fig. 3 shows a similar vesicle close to the nucleus 

 of the endothelial cell. Here the small cell organelles 



