Renal biopsy in a patient with pre-eclampsia shows glomerular endotheliosis on electron microscopy. Which of the following best describes this pathognomonic finding?

• A Fibrin thrombi within glomerular capillaries with cortical necrosis
• B Swelling of glomerular endothelial cells with loss of fenestrations and occlusion of capillary lumens ✓
• C Subepithelial immune complex deposits with spike formation on silver stain
• D Mesangial proliferation with IgA-dominant immune deposits

Explanation

Glomerular endotheliosis is the hallmark renal lesion of pre-eclampsia, characterized by swelling of glomerular endothelial and mesangial cells with loss of endothelial fenestrations, leading to occlusion of capillary lumens. This is visible only on electron microscopy and explains the proteinuria and decreased GFR. Fibrin thrombi with cortical necrosis is seen in thrombotic microangiopathies. Subepithelial deposits with spikes are seen in membranous nephropathy. Mesangial IgA deposits are characteristic of IgA nephropathy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.