INTRODUCTION. Hereditary nephropathy is clinically characterized by the
familial occurrence in successive generations of progressive haematuric
nephritis and neural hearing loss. Hereditary nephropathy of Alport?s
syndrome (AS) and benign familial (recurrent) haematuria (BFH) are
morphologically characterized by specific and diagnostically important
thickening and splitting of lamina densa of the glomerular basement
membranes. Those lesions can be recognized only by electron microscopy.
Hereditary nephritis is usually present clinically with haematuria, and new
mutations without a family history of haematuria. It is therefore important
to differentiate hereditary nephritis from BFH and no familial haematuria.
Thus, electron microscopy is essential in diagnosis of haematuria. OBJECTIVE.
The aim of this study was to describe, by light microscopy, constellation of
renal alterations by which hereditary nephropathy can be recognized with high
probability as well as to compare the diagnostic validity of the findings
observed by light and electron microscopy in AS and BFH. METHOD. We examined
48 renal biopsies of the patients with hereditary nephoropathies by light and
electron microscopy. Tissue samples were fixed in buffered paraformaldehyde
and embedded in paraffin for long-term preservation. For the electron
microscopy analysis, the following fixation in 4% glutaraldehyde tissue was
postfixed in 1% osmium tetroxide. Thereafter, the following dehydration
procedure tissue slices were embedded in epon. RESULTS. Our results
demonstrated that the interstitial foam cells, foetal-like glomeruli, minimal
glomerular abnormalities with stain less intense in basement membranes, mild
irregular mesangial widening, focal thickening of Bowman?s capsule, foci of
dilatation tubules, tubular ectasia and atrophy, erythrocyte tubules casts
were present in hereditary nephritis. Additionally, light microscopic biopsy
findings in patients with BFH were either normal or revealed minor changes
(e.g. increased mesangial matrix). All biopsies were reevaluated by electron
microscopy and ultrastructural findings confirmed the diagnosis of hereditary
nephropathies. CONCLUSION. The findings observed by light microscopy
represent an important step that leads to a definitive diagnosis of AS and
BFH. The definitive diagnosis, however, depends on electron microscopy.