This biopsy from an 80-year-old male with acute kidney injury shows glomeruli with frequent rupture of the capillary loops and Bowman’s capsule, associated with fibrinoid necrosis of the glomerular tuft and cellular crescent formation (Fig 1). Of note, there are scattered multinucleated giant cells within the involved glomeruli. Immunofluorescence shows diffuse and global bright linear staining of the capillary loops for IgG (Fig 2), kappa and lambda. These findings are diagnostic of anti-glomerular basement membrane disease. Multinucleated giant cells are significantly more common in anti-glomerular basement membrane disease when compared to ANCA-associated glomerulonephritis, and may serve as a marker of the former in cases lacking serologic data and/or tissue available for immunofluorescence studies.
Reference: Messias NC, Ambruzs JM, Walker PD, et al. Multinucleated giant cells are a common marker of Anti-GBM disease but not ANCA-related Glomerulonephritis. Modern Pathol. 2014; 27 (S2) 413.
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