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Am J Physiol Renal Physiol 284: F1014-F1022, 2003. First published January 14, 2003; doi:10.1152/ajprenal.00273.2002
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Vol. 284, Issue 5, F1014-F1022, May 2003

Determinants of GFR depression in early membranous nephropathy

M. A. Hladunewich, K. V. Lemley, K. L. Blouch, and B. D. Myers

Divisions of Nephrology, Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, California 94305

We evaluated the glomerular filtration rate (GFR) in 34 subjects with membranous nephropathy (MN) of new onset. We used physiological techniques to measure GFR, renal plasma flow, and oncotic pressure and computed a value for the two-kidney ultrafiltration coefficient (Kf). A morphometric analysis of glomeruli in the diagnostic biopsy permitted computation of the single-nephron ultrafiltration coefficient (SNKf). MN subjects were divided into two groups: moderate or severe, according to whether GFR was depressed by less or more than 50%. SNKf was subnormal but similar in moderate and severe MN. In contrast, two-kidney Kf was significantly more depressed in severe than in moderate MN. We estimated the total number of functioning glomeruli (Ng) by dividing two-kidney Kf by SNKf. Whereas mean Ng was similar in controls and moderate MN (1.5 and 1.4-1.7 × 106, respectively), it was significantly lower in severe MN (0.5 × 106). This degree of glomerulopenia was not reflected in the rate of global sclerosis. We conclude that a combination of depressed SNKf (due to foot process broadening) and profound glomerulopenia accounts for GFR depression of >50% early in the course of MN. The cause of the glomerulopenia remains to be elucidated.

glomerular filtration rate; glomerular hemodynamics; ultrafiltration coefficient; glomerular morphometry; glomerular number





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