Digital glomerular reconstruction in a patient with a sporadic adult form of glomerulocystic kidney disease

This study describes a sporadic adult form of glomerulocystic kidney disease in a 52-year-old man. To determine whether the aperture of the proximal tubule was stenosed or obstructed to clarify the pathogenesis of glomerular cyst development, 100 serial sections of the open biopsy specimen were made. Ten glomerular cysts were reconstructed using three-dimensional imaging analysis. Bowman's capsule (glomerular cyst) volume, the volume of glomerular tufts, and the area of the proximal tubular opening were estimated using imaging analysis. The volumes of Bowman's capsule and of glomerular tufts were 0.0098 +/- 0.0039 mm(3) (mean +/- SD) (normal: 0.0041 to 0.0083 mm(3)) and 0.0026 +/- 0.0013 mm(3), respectively. The area of the proximal tubular opening was 0.0017 +/- 0.0003 mm(2) (normal: 0.0012 to 0.0028 mm(2)). There was neither obstruction nor stenosis of the opening of the renal tubule in this sporadic adult form of glomerulocystic kidney disease. After 4 years of hemodialysis, the glomerular cysts, as well as the kidneys, enlarged. This study shows that the main cause of glomerular cyst development is not glomerulotubular neck obstruction. (C) 2000 by the National Kidney Foundation, Inc.