The Nephrotic Syndrome in Secondary Syphilis

Abstract

A case of the nephrotic syndrome in secondary syphilis was studied with renal biopsies before and after clinical cure. The initial biopsy demonstrated endothelial proliferation on light microscopy; and on electron microscopy showed swelling of the endothelial cells, electron dense deposits adjacent to either side of the basement membrane, and fusion of the epithelial cell foot processes. The 2nd biopsy, done after complete clearing of the nephrotic syndrome showed disappearance of all histological abnormalities except for an occasional deposit adjacent to the basement membrane. These findings were considered to demonstrate clearly the glomerular origin for the proteinuria of the nephrotic syndrome in secondary syphilis. The similarity of the microscopic lesions in this case to those of membranous glomerulonephritis was noted. Reversibility of the glomerular lesion in membranous glomerulonephritis is related to the type, severity, and duration of the initial insult in conjunction with the presence or absence of a mechanism for perpetuating the disease process.