A PROVOCATIVE histological study of the changes in the kidney associated with toxemia is reported in this issue of The Journal, p. 791. Prior to 1951, histological knowledge of this condition was derived from autopsy findings which were clouded by postmortem changes. During the past decade percutaneous kidney biopsy has been developed. This technique, perfected by Altchek and others, provides an excellent method for obtaining kidney tissue. When the specimen is examined by the electron microscope, a new concept of the pathogenesis of toxemia is evolved.
The glomeruli appear to be involved equally and each glomerulus in proportion to the severity of the disease. Three aspects of toxemia first described by Altchek are defined: the cytoplasm of the endothelial or capillary wall cell is swollen; a deposit of an amorphous material in the endothelial cytoplasm and under the basement membrane is observed; and an increase in the number of intercapillary