A Case of “Pure” Preeclampsia With Nephrotic Syndrome Before 15 Weeks of Gestation in a Patient Whose Renal Biopsy Showed Glomerular Capillary Endotheliosis  Toshiyuki Imasawa, MD, Tetsuji Nishiwaki, MD, Motonobu Nishimura, MD, Nobuaki Shikama, MD, Ryutaro Matsumura, MD, Masaaki Nagai, MD, Akiko Soyama, MD, Kentaro Koike, MD, Hiroshi Kitamura, MD, Kensuke Joh, MD  American Journal of Kidney Diseases  Volume 48, Issue 3, Pages 495-501 (September 2006) DOI: 10.1053/j.ajkd.2006.05.024 Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 1 (A) In intracapillary lumina with prominently swollen glomerular endothelial cells, glomerular basement membranes have split, resulting in narrowing of the capillary lumina. Partial mesangiolysis also is observed (arrow). (B) This glomerulus is collapsing, probably because of ischemia caused by swelling of afferent artery endothelial cells and obstruction of the lumen (arrowhead). Glomerular epithelial cells are swelling. (C) There are severe subendothelial fibrinoid deposits. (D) Swelling also is observed in endothelial cells of interlobular arteries (arrow). (Periodic acid–methenamine silver stain; original magnification ×400.) American Journal of Kidney Diseases 2006 48, 495-501DOI: (10.1053/j.ajkd.2006.05.024) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 2 (A). The pattern of IgM staining is peripheral, which should indicate exudation of serum. (IgM staining; original magnification ×200.) (B) Fibrin deposits are detected (arrows). (Phosphotungstic acid hematoxylin staining; original magnification ×400.) (C) Platelet thromboses are observed in the glomerular capillary lumina (arrows). (Factor VIII staining; original magnification ×400.) (D) Glomerular capillary lumina have become extensively narrow. (CD34 staining; original magnification ×400.) American Journal of Kidney Diseases 2006 48, 495-501DOI: (10.1053/j.ajkd.2006.05.024) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 3 Electron microscopy shows no electron-dense deposits in any area of glomeruli. Foot-process formation is normal. Swollen glomerular endothelial and epithelial cells are conspicuous. (Original magnification: [A], ×1,500; [B], ×5,000.) American Journal of Kidney Diseases 2006 48, 495-501DOI: (10.1053/j.ajkd.2006.05.024) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions