Renal biopsy pathology in Wegener's granulomatosis

Eighteen renal biopsies from 10 patients with active generalized Wegener's granulomatosis (GWG), with GWG in remission on therapy, and with active localized Wegener's granulomatosis (LWG) have been examined by light and electron microscopy. In all 9 patients with active GWG, light microscopy revealed focal and segmental glomerulonephritis. Electron microscopy revealed subepithelial basement membrane densities resembling immune complex deposits in two biopsies from patients with active GWG. In biopsies from patients on cytotoxic therapy, there was no active inflammatory process, but focal glomercular obsolescence and segmental tuft sclerosis provided evidence of prior focal and segmental glomercular disease. Discrete zones of basement membrane crimping and increased mesangial material along the capillary wall were observed in some patients with apparent LWG, as well as proven GWG, possibly representing foci of previous glomerular injury. The appearance of dense deposits on the epithelial side of the basement membrane suggests that immune complex deposition in the glomeruli may be at least partially responsible for the renal injury in Wegener's granulomatosis.