The ultrastructural abnormalities of the kidney were studied in 14 cases of steroid-resistant nephrotic syndrome in children. It is emphasized that none of the individual glomerular alterations is distinctive of any typical process. When, however, considered in their entire pattern, they permit to distinguish two well-defined types. The cases revealing alterations of the epithelium and of the basement membrane correspond clinically to the nephrotic syndrome and histologically to membranous glomerulonephritis. In contradistinction to this type, the group where the mesangium and the endothelial cells are prevalently affected may be associated with the clinical syndrome of nephrosis or nephritis and with the histological features of membranous or membranoproliferative glomerulonephritis. The membrano-epithelial type responds favourably to immunosuppressive treatment, in contrast to the mesangio-endothelial type which is generally unresponsive.
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