Proteinuria occurs due to renal glomerular endotheliosis
, a manifestation of widespread endothelial damage in preeclampsia.
The predominant target organ may be the brain (seizures or eclampsia), the liver (HELLP syndrome), or the kidney (glomerular endotheliosis
5,6) The proteinuria of preeclampsia is associated with a pathognomonic renal lesion known as glomerular endotheliosis
, in which the endothelial cells of the glomerulus swell and endothelial fenestrations are lost.
19] Due to glomerular endotheliosis
, there may be increased leakiness of the glomerular filtration membrane and also there is reduced renal blood flow and tubular function.
Glomerular capillary endotheliosis
in toxemia of pregnancy.
This loss of morphology and function is most evident in the glomerular endothelium, which shows the classic histological finding of endothelial cell swelling, called endotheliosis
, and microvascular obstruction (10).
For example, proteinuria in pre-eclampsia is associated with a specific endothelial renal lesion, glomerular endotheliosis
, and the hypertension is thought to be a secondary effect to diffuse endothelial dysfunction.
Pharmacological and genetic disruptions of VEGF have been shown to result in significant proteinuria and glomerular endotheliosis
[Eremina et al.
has been described as the classic pathologic renal lesion of preeclamptic women.
Moreover, in the absence of a protein calibrator applicable to the wide variety of urinary proteins that are excreted, albumin rather than protein mixtures has been recommended as a calibrator, because albumin is the 1st protein to increase in urine and the main protein excreted in many glomerular disorders, including glomerular endotheliosis
In unadjusted models, higher concentrations have been associated with the degree of endotheliosis
in women with preeclampsia, a condition also believed to be attributable to endothelial damage (18).