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A series of 126 adult patients with a serologically confirmed diagnosis of nephropathia epidemica (NE) were studied during the acute phase of the disease. In 86 cases, renal biopsy was performed. The severity of renal failure correlated slightly with blood inflammatory parameters and the degree of hematuria but not with the amount of proteinuria. The degree of hematuria correlated inversely with the level of thrombocytopenia. The most common histopathologic lesion was acute tubulointerstitial nephritis. Interstitial edema and inflammatory cell infiltrations were most usually present, followed by tubular epithelial and luminal alterations. Slight glomerular mesangial changes were present in 25% of the biopsy specimens. Except for hemorrhage in the outer renal medulla, the histologic lesions were relatively mild and unspecific. Interstitial hemorrhage should remind a pathologist of the possibility of NE. Tubular, interstitial and glomerular histologic damage were but vascular lesions were not associated with the clinical severity of renal failure. Glomerular alterations did not relate to the amount of urine protein excretion. Correlations, however, were so weak that in clinical work renal biopsy is usually not indicated for determination of the severity of renal failure in NE. Intrinsic renal events are probably important in the development of renal failure in NE.

An improved fine needle is described for aspiration of kidney glomeruli. The needle, with a sharp inner edge 0.43 mm in diameter, is less traumatic than ordinary percutaneous kidney biopsy needles. Electron microscopy of specimens aspirated from kidneys of normal rabbits showed well-preserved glomeruli. Twenty-two of twenty-six specimens obtained from human kidneys by fine-needle aspiration contained glomeruli. Electron microscopic study of specimens aspirated from 12 patients showed that the needle provides adequate tissue for the diagnosis of diffuse glomerular diseases. The use of the fine needle widens the scope for studying the relation between glomerular fine structure and renal symptoms in many conditions in which conventional methods would not be justified.

39 patients with malignant neoplasms were studied for the presence of paraneoplastic glomerular disease. The nephrotic syndrome was found in none of the patients. From 24 patients an adequate renal biopsy specimen was available for examination by electron microscopy. Glomerular electron-dense deposits were found in the biopsies of 11 patients, and in four of them the deposits were subepithelial. Circulating soluble immune complexes were detected in the sera of 14 patients. Deposits and circulating immune complexes occurred simultaneously with a highly significant correlation. Cell-mediated immunity was studied using skin tests to tuberculin and dinitrochlorobenzene (DNCB). Negative tests were seen mainly in patients with circulating immune complexes and/or glomerular deposits. Median survival time in patients with deposits or circulating complexes tended to be shorter than in those without.