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 VOLUME Vol.05 Issue06 2025 

PAGE NO. 31-37 

DOI 10.37547/ajbspi/Volume05Issue06-08 

 
 
 
 

Characteristics of Morphometric Indicators of The 

Kidneys in Gestancial Pyelonephritis According to 

Pregnancy Parity 
 

Tojiboev Timur 

Andijan State Medical Institute, assistant, Uzbekistan 

 

Khonkeldieva Hurmatoy 

Associate Professor, Doctor of Medical Sciences, Andijan State Medical Institute, Uzbekistan 

 

Ahmedova Muslima 

Andijan State Medical Institute, Assistant, Uzbekistan 

 

 

Received: 30 April 2025; Accepted: 28 May 2025; Published: 30 June 2025 

 

Abstract: Basically, the morphometric parameters of the cells and fibrous structures of the kidney in the 
morphofunctionally actively stained areas were taken as the basis for expressing the trajectory of the values 
measured during the morphometry process within a certain range by numbers. The specific features of the 
morphometric parameters of the parenchymal and mesenchymal structures of the kidneys of 40 women who died 
from gestational pyelonephritis, who underwent autopsy at the Republican pathologoanatomical center of 
Uzbekistan, were studied using the Hamamatsu (QuPath-0.4.0, NanoZoomer Digital Pathology Image) 
morphometric software. To determine the morphometric parameters, the location, size, area occupied, size of 
cells, width of blood vessels, diameter, perimeter, volume of lumens in a given volume and other indicators were 
obtained. In the study, the superiority of all morphofunctional parameters over the control group was up to 1.35 
times in the I-pregnancy, up to 1.2 times in the II-pregnancy, which was explained by the weakness of 
morphological adaptation mechanisms, a decrease in the age-related reactivity of vascular components. 

 

Keywords: Borphometry, kidney, gestational pyelonephritis, pregnancy. 

 

Introduction: According to the WHO (2022), pregnant 
women make up an average of 11.7% of the world's 
population. During the second and third trimesters of 
pregnancy, the development of morphofunctional 
obstructions in the urinary system can occur, leading to 
compression of the ureters coming from the kidneys. 
This causes urinary stasis and, with the addition of 
infectious agents, results in the development of 
gestational pyelonephritis [1, 2, 6]. 

The incidence rate of gestational pyelonephritis 
corresponds to the number of pregnancies and births 
and is observed in approximately 2–4% of all pregnant 
women in the United States and European countries, 
around 2–3% in Japan, South Korea, and India, and on 

average 2–10% in CIS countries and the Russian 
Federation. In the Republic of Uzbekistan, this indicator 
averages 10–18%. The development of gestational 
pyelonephritis during childbirth and the postpartum 
period accounts for approximately 6–25%, 
underscoring the urgency of the problem. 

The mortality rate due to kidney complications arising 
during pregnancy and the postpartum period is on 
average 1–3% per 1000 pregnant women [3, 4, 5]. 

Research aim and objectives 

To study the changes in renal morphometric 
parameters in gestational pyelonephritis depending on 
pregnancy parity. 

 

https://doi.org/10.37547/ajbspi/Volume05Issue06-08
https://doi.org/10.37547/ajbspi/Volume05Issue06-08
https://doi.org/10.37547/ajbspi/Volume05Issue06-08
https://doi.org/10.37547/ajbspi/Volume05Issue06-08


American Journal of Applied Science and Technology 32 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

METHODS 

The study was conducted at the Republican Center of 
Pathological Anatomy between 2020 and 2023 and 
involved 40 women who died during pregnancy due to 
renal pathologies. The specific morphometric 
characteristics of the renal parenchyma and 
mesenchymal structures in cases of gestational 
pyelonephritis were analyzed using the Hamamatsu 
(QuPath-0.4.0, NanoZoomer Digital Pathology Image) 
morphometric software. 

RESULTS 

For morphometric examination, kidney tissue samples 
were obtained from the autopsies of patients who 
suddenly died of myocardial infarction (control group, 
n=17). As the experimental group, kidney tissue 
samples were taken from autopsies of women of 
various reproductive ages who died during pregnancy 
due to acute renal diseases. The prepared kidney tissue 
materials were scanned using the NanoZoomer, and 
microimages were obtained. 

Morphometric parameters were determined based on 
cellular localization, volume, occupied area, size, width, 
diameter, perimeter, lumen volume of blood vessels, 
and other relevant indicators within a defined volume. 

Specifically, morphometric analysis identified 

dystrophic changes in the functional active areas of the 
renal parenchymal components, while inflammatory 
changes were observed in the mesenchymal parts, such 
as the glomeruli and tubules, which serve as key 
indicators of pathological alterations. 

Our study revealed distinctive features of the examined 
tissue, including the complete integrity of all 
glomerular blood vessels, a 17–28% increase in 
glomerular weight compared to the control group, 
focal detachment in the epithelium of proximal and 
distal tubules, presence of coarse proteinaceous 
inclusions in the cytoplasm, massive multifocal 
desquamation in the epithelium, and nuclei exhibiting 
karyopyknosis, karyorrhexis, and karyolysis due to 
necrobiosis. Additionally, thickening of the basal 
membrane of proximal tubules, accumulation of coarse 
homogeneous proteinaceous substrate in the lumen of 
distal tubules, massive congestion of peritubular 
capillaries, diapadesis hemorrhages, and a significant 
decrease in reabsorption capacity of proximal tubules 
were observed. 

Morphometrically, the changes associated with 
gestational pyelonephritis were studied according to 
the number of pregnancies. 

  

Table 3.1. 

Morphometric Parameters (number and micrometers) of Renal Injury Areas in 

Gestational Pyelonephritis 

Studied Parameters Control Group I Trimester II Trimester III 

Trimester 

R ≤ 0.01 

Average diameter of renal 

glomeruli 

166.8±1.1 209.3±1.1 191.1±1.01 173.2±1.1 0.01 

Glomerular perimeter 256.7±1.03 343±1.05 314.5±1.1 293.1±1.21 0.01 

Area occupied by the 

glomerular tuft (15000 

µm²) 

10365±5.61 12281±3.25 10995±8.3 10725±2.9

2 

0.01 

Shumlyansky–Bowman 

space 

18.31±1.01 15.21±1.01 17.42±0.97 18.21±1.01  

Proximal 121.12±5.01 162.11±8.16 152.5±7.13 135.31±5.21 0.01  



American Journal of Applied Science and Technology 33 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

tubule 

diameter 

Proximal 

tubule lumen 

diameter 

Proximal 

tubule 

perimeter 

Proximal 

tubule area 

(µm²) 

43.01±0.01 36.2±1.01 37.1±1.01 39.2±1.01 0.01  

243.12±1.65 284.15±1.16 265.31±1.32 251.42±1.2 0.01  

716.48±312.6

5 

774.1±1.12 745.1±1.76 725.1±1.1 0.01  

Distal tubule 

diameter 

61.12±1.4 84.36±12.5 78.14±1.6 68.11±1.3 0.01  

Collecting 

duct lumen 

diameter 

31.16±6.59 42.18±6.25 39.7±1.4 34.01±1.06 0.01  

Collecting 

duct 

perimeter 

121.24±2.8 169.72±25.1 156.28±3.2 136.21±2.6 0.01  

Collecting 

duct area 

(µm²) 

1299.97±22.8

4 

1559.96±23.4 1374.13±11.

15 

1274.29±12.

52 

0.01  

 

 



American Journal of Applied Science and Technology 34 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

Figure 1. In the image, centrally located dilated tubules appear irregularly oval 

in shape and have undergone compressive deformation. Scanned using NanoZoomer. 

Staining: H&E. Size: 20×10. 

The average diameter of the renal glomeruli in the 
control group was 166.8±1.1 µm. In comparison, this 
parameter increased to 209.3±1.1 µm in the kidneys of 
the first group of pregnant women with gestational 
pyelonephritis during the first trimester, showing a 
1.25-fold increase. These changes correspond to the 
morphological signs described above, particularly the 
vascular response within the glomerular capillary 
network. The observed increase in filtration, marked 
vasodilation, and enlargement of the glomeruli confirm 
that these alterations are most pronounced in 

gestational pyelonephritis occurring during the first 
trimester. 

In the second trimester, this indicator measured 
191.1±1.01 µm. From an age-related perspective, this 
is explained by a reduction in vascular elasticity, and 
compared to the first-trimester group, vessels became 
more fragile and thickened. As a result, the extent of 
vasodilation was less pronounced. Nevertheless, this 
parameter was still 1.15 times higher than that of the 
control group, confirming its significance. 

 

 

Figure 2. Graphical representation of the average perimeter of the 

Shumlyansky–Bowman’s space of the renal glomerulus. Scanned using NanoZoomer. 

Staining: H&E. Size: 20×10. 

In the third trimester, the same parameter measured 
173.2±1.1 µm. This value can be explained by age-
related changes, such as a marked reduction in vascular 
elasticity, increased fragility of blood vessels compared 
to groups I and II, and a decrease in elastic fibers within 
the vessel walls. Additionally, reduced reabsorption 
capacity in the renal tubules contributes to this finding. 
The parameter was 1.03 times higher than that of the 
control group, confirming its significance. 

As for the glomerular perimeter, it was 256.7±1.03 µm 
in the control group, while in the first trimester group, 
it increased to 343±1.05 µm. This represents a 1.34-fold 
increase, indicating significant vascular congestion 
within the glomeruli and intensified filtration 
processes, which in turn led to the expansion of 
Bowman’s space, thus supporting the observed 
morphological findings. 

 



American Journal of Applied Science and Technology 35 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

 

Figure 3. The renal glomerulus with illustrated epimetric and perimetric 

measurements of the Shumlyansky–Bowman’s space, showing one-quarter of the 

segmental diagonal diameter. Scanned using NanoZoomer. Staining: H&E. Size: 

20×10. 

In the second group (i.e., during the second trimester 
of pregnancy), the perimeter of the renal glomeruli was 
314.5±1.1 µm, showing a 1.22-fold enlargement. This 
enlargement is explained by damage to the glomeruli 
during chemotherapeutic treatment for gestational 
pyelonephritis and by an increase in filtration 
parameters. 

In the third group (i.e., third trimester of pregnancy), 
the glomerular perimeter measured 293.1±1.21 µm, 
which is 1.14 times greater than in the control group. 
This finding indicates a reduced adaptive response in 
this stage of pregnancy. 

The next morphometric indicator is the average area 
occupied by the glomerular tuft (15000 µm²). In the 

control group, this area was 10365±5.61 µm², whereas 
in the first trimester, it increased to 12281±3.25 µm², 
confirming the results observed in the other 
morphometric measurements. In terms of the 
proportion of the glomerulus occupied by the capillary 
tuft, 69.1% of the area was occupied in the control 
group, compared to 82% in the first group. This 
indicates pronounced vascular dilation and elevated 
filtration capacity, as well as ongoing vascular damage 
occurring in parallel. These findings collectively support 
the notion that renal insufficiency may develop 
following any course of chemotherapeutic treatment 

 



American Journal of Applied Science and Technology 36 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

 

Figure 4. Morphogram showing the perimeter, external diameter, and internal 

(luminal) diameter of the proximal and distal renal tubules. Scanned using 

NanoZoomer. Staining: H&E. Size: 20×10. 

In the second group (i.e., second trimester of 
pregnancy), the area occupied by the glomerular tuft 
was 10,995±8.3 µm², comprising 73.3% of the total 
glomerular area (15,000 µm²). Compared to the control 
group, this represents a 4.2% increase, although 
statistically of low significance. 

In the third group (third trimester), the tuft area 
measured 10,725±2.92 µm², accounting for 71.5% of 
the total, which is very close to the control group and 
statistically not significant, indicating that vascular 
reactivity in the glomeruli during this period does not 
differ substantially from the baseline. 

The next stage of examination focused on the 
Shumlyansky–Bowman’s space, which is critical for 
evaluating the morphofunctional characteristics of the 
glomeruli. In the control group, the average width of 
this space was 18.31±1.01 µm, while in the first 
trimester group, it decreased to 15.21±1.01 µm, 
indicating a narrowing of Bowman’s space. This is 
interpreted as a result of the marked enlargement of 
the capillary tuft and vascular hyperemia, reducing the 
available space. This reflects a 1.2-fold decrease. 

In the second trimester, the Bowman’s space measured 
17.42±0.97 µm, showing a 10.5% reduction compared 
to the control group, which was considered statistically 
less significant. 

In the third trimester, the measurement was 
18.21±1.01 µm, with no meaningful difference from the 
control group. This suggests that the structure and 
function of the glomerular tuft and Bowman’s space 

remained largely intact. 

Subsequent morphometric analysis involved 
measurements of renal tubules in various projections, 
comparing them to the control group. 

For the proximal tubules, the average diameter in the 
control group was 121.12±5.01 µm, while in the first 
trimester, it expanded to 162.11±8.16 µm, showing a 
1.2-fold increase. This can be attributed to increased 
filtration activity, enhanced reabsorption, and the 
development of dystrophic changes in tubular 
epithelium, leading to cellular swelling and tubular 
dilation. 

In the second trimester, the proximal tubule diameter 
reached 152.5±7.13 µm, 1.15 times larger than the 
control group. This reflects ongoing epithelial damage, 
with histological evidence (at 200× magnification) of 
dystrophic changes, including hyaline droplet 
degeneration and hydropic degeneration. Notable 
findings included epithelial detachment, cellular 
desquamation, and karyolysis-like foci. 

In the third trimester, the proximal tubule diameter 
was 135.31±5.21 µm, 1.12 times larger than in the 
control group, and was considered statistically 
significant. This enlargement is attributed to various 
degrees of epithelial swelling. 

The inner diameter of the proximal tubules in the 
control group was 43.01±0.01 µm. In the first trimester, 
this reduced to 36.2±1.01 µm, a 1.2-fold decrease, 
primarily due to enlargement of epithelial cells. In the 
second trimester, the diameter was 37.1±1.01 µm, 



American Journal of Applied Science and Technology 37 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

indicating a 1.15-fold reduction, with less pronounced 
changes with age. 

In the third trimester, the inner diameter was 
39.2±1.01 µm, showing a 1.1-fold decrease compared 
to the control group, but this difference was not 
statistically significant. 

Regarding the distal tubule diameter, it measured 
61.12±1.4 µm in the control group, while in the first 
trimester, it reached 84.36±12.50 µm. This increase 
reflects tubular enlargement and corresponds with the 
presence of dystrophic and necrobiotic changes in the 
epithelium. 

In the second trimester, the distal tubule diameter was 
78.14±1.6 µm, 1.3 times larger than in the control 
group. In older individuals (ages 60–74), this 
measurement averaged 68.11±1.3 µm, which is 1.11 
times larger than controls, although the difference was 
statistically insignificant. These findings indicate that 
age-related reductions in adaptive capacity contribute 
to a lesser degree of change in the distal tubules 

CONCLUSIONS 

Multiplex morphometric studies revealed that age-
related renal damage indicators were significantly 
elevated in all study groups compared to the control 
group. In the first trimester of pregnancy, 
morphofunctional parameters were markedly 
elevated, with more pronounced damage observed. On 
average, the size of all renal components increased by 
up to 1.35 times relative to the control group, reflecting 
vascular dilation and overall morphological dominance 
of injury features, making this the most affected group. 

In the second trimester, these parameters were, on 
average, up to 1.2 times higher than in the control 
group. This was explained by weaker rapid 
morphological adaptation mechanisms and a decline in 
vascular component responsiveness due to age-related 
changes. In this group, renal damage indicators showed 
10–15% variability compared to the control group, 
confirming moderate but notable pathological 
differences.  

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Stepan'kova E.A., et al. Pyelonephritis and pregnancy. 
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