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Published on: February 20, 2015
Renal disease in Marfan syndrome
G D Sbar1, V S Venkataseshan, Z Huang
1Department of Pathology, Barnert Hospital, Paterson, N.J. 07514, USA.
Abstract:
We encountered 4 individuals with Marfan syndrome who presented with microhematuria and proteinuria. In 2 of them, a renal biopsy was performed. The predominant glomerular change by light microscopy was a focal segmental increase in mesangial matrix with early sclerotic lesions. Ultrastructurally, there was variable subendothelial widening containing haphazardly arranged microfibrils, 10-13 nm in diameter. Changes in small arteries present in the biopsies were mild in case 1 and more striking in case 2 which consisted of elastolysis and fragmentation and focal disruption of internal elastic lamina, and focal degenerative changes in the media. In light of observations on the abnormalities of microfibrillar protein (fibrillin) in the microfibrillar-fiber system and the presence of abnormal type IV collagen in the connective tissues in Marfan syndrome, the glomerular basement membrane alterations may be related to these defects and lead to microhematuria and proteinuria.
Insights
Marfan syndrome patients can experience kidney problems like microhematuria and proteinuria. Renal biopsies revealed glomerular and arterial changes linked to connective tissue defects in this genetic disorder.
Area of Science:
- Nephrology
- Genetics
- Pathology
Background:
- Marfan syndrome is a genetic connective tissue disorder affecting multiple organ systems.
- Kidney involvement in Marfan syndrome is not well-characterized, but renal abnormalities can occur.
Observation:
- Four individuals with Marfan syndrome presented with microhematuria and proteinuria.
- Renal biopsies in two patients showed focal segmental mesangial matrix increase and early sclerosis.
- Ultrastructural analysis revealed subendothelial widening with abnormal microfibrils and arterial wall changes including elastolysis.
Findings:
- Glomerular basement membrane alterations were observed in Marfan syndrome patients with proteinuria and microhematuria.
- Arterial changes in renal biopsies included elastolysis and fragmentation of the internal elastic lamina.
Implications:
- These renal findings suggest a potential link between Marfan syndrome's connective tissue defects (fibrillin, collagen IV) and glomerular basement membrane pathology.
- Understanding these kidney manifestations is crucial for comprehensive Marfan syndrome patient management and monitoring.
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