Clinical, light, and electron microscopy findings in idiopathic haematuria

The electron microscopic findings are reported in detail in 20 patients submitted to renal biopsy with the major complaint or clinical finding of gross or microscopic haematuria. The lesions were classified histologically into four groups: group 1, minor glomerular alterations; group 2, focal mesangial thickening and/or cellular proliferation; group 3, diffuse mesangial proliferation; and group 4, other lesions. The major ultrastructural alterations included irregularity in thickness and density of the capillary basement membrane, with apparent discontinuity and bi- or multilaminar splitting of the lamina densa. There were varying degrees of foot process fusion, visceral epithelial polykaryocytosis, and granular deposits related to the capillary basement membrane. Densities were found in the mesangial basement membrane-like material, which was often markedly increased in quantity. A few microtubular aggregates were observed in endothelial cell cytoplasm. Changes consistent with acute diffuse proliferative and membrano-proliferative glomerulonephritis were also seen. The significant clinical findings, histological groups, and ultrastructural changes are correlated.

Symptomless haematuria in childhood

The clinical, laboratory, and renal biopsy findings in 47 children with symptomless haematuria are reported. In 41 the haematuria was recurrent. Local causes were excluded by means of intravenous urography, which was normal in all but one child, who had a horseshoe kidney.Since all the patients had presented in a similar manner they were classified into four groups according to the severity of glomerular changes on renal biopsy. In group I the glomeruli were optically normal. In group 2 they showed a variable degree of mesangial thickening with absent or minimal cellular proliferation. In group 3 there was diffuse mesangial thickening and proliferation-an appearance indistinguishable from that of subsiding post-streptococcal glomerulonephritis. Compared with groups 1 and 2, more patients in this group had persistent proteinuria, as well as evidence of streptococcal infection preceding the initial haematuria. Only two patients showed severe proliferative glomerulonephritis on biopsy (group 4); both had heavy proteinuria and one repeatedly had low serum beta1(c)-globulin levels.