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The number and distribution of glomerular anionic sites using polyethyleneimine (PEI) and the ultrastructural changes in the adjacent glomerular basement membrane (GBM) of 33 children with nephrotic syndrome were studied. Compared to the number of PEI-labelled anionic sites in the lamina rara externa per 1000 nm length of the GBM in eight controls (mean +/- SD, 25.0 +/- 1.49); there was a significant decrease in four patients with minimal change nephrotic syndrome (MCNS; 15.25 +/- 2.98, P &lt; 0.05); 10 patients with focal glomerulosclerosis (16.0 +/- 5.1, P &lt; 0.014); 14 patients with membranous nephropathy (14.1 +/- 3.83, P &lt; 0.009), and five patients with membranoproliferative glomerulonephritis (20.04 +/- 1.69, P &lt; 0.036). A moderate inverse correlation between anionic site numbers and proteineuria (estimated by urinary protein creatinine ratio) was found in MCNS only (r = -0.6). These findings suggest that a reduction in the glomerular anionic sites may be only partly responsible for proteineuria in the different types of childhood nephrosis, except for minimal change nephrotic syndrome, where it probably plays a major role.

Depletion of glomerular anionic sites and proteineuria in nephrotic syndrome of children