Elsevier

Kidney International

Volume 59, Issue 6, June 2001, Pages 2069-2072
Kidney International

Cell Biology – Immunology – Pathology
Red cell traverse through thin glomerular basement membranes

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Red cell traverse through thin glomerular basement membranes.

Background

How red cells enter the urinary filtrate in most cases of hematuria of glomerular origin has remained a mystery despite the frequent ultrastructural examination of renal biopsy material.

Methods

Serial sections of glutaraldehyde-fixed, resin-embedded material from a case of sporadic microhematuria were examined by transmission electron microscopy when the site of a red cell traversing the glomerular capillary wall was fortuitously discovered on routine examination.

Results

The red cell assumed a dumbbell shape and traversed a localized gap 2.25 μm in diameter in the glomerular endothelium and basement membrane. Serial sections suggested a transcellular route. Apart from the thinning of the basement membrane (167 nm), there were no other generalized abnormalities.

Conclusion

Red cells can traverse through gaps in the glomerular capillary walls to gain access to Bowman's space. This may be the origin of glomerular hematuria in common noninflammatory forms of glomerular disease, including thin basement membrane nephropathy.

Keywords

hematuria
thin membrane nephropathy
urinary infiltrate
endothelium
segmental basement membrane
microhematuria
capillary wall gap

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