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Diagnose This (August 2, 2022)

Clarissa Cassol, MD renal pathologist at arkana laboratories
By Clarissa Cassol, MD

Aug 02, 2022

class IV lupus nephritis on IF stain

These are the C1q and C3 stains of the biopsy of a 13-year-old female with hematuria and proteinuria. Given these findings, what is your main differential diagnosis.



The biopsy shows mesangial and capillary wall staining for C3 and C1q, as well as peritubular capillary staining for C3. The presence of strong C3 and C1q (both 3+) excludes the possibility of C3 Glomerulopathy, and the presence of extra-glomerular staining (peritubular capillary) suggests underlying autoimmune diseases, such as SLE. There was also IgG and IgA staining. By light microscopy, there was endocapillary hypercellularity, and no GBM lucencies or spikes.  Ultrastructurally, numerous mesangial (star) and subendothelial (arrows) electron dense deposits were present. Indeed, the patient had SLE and this was diagnosed as a class IV lupus nephritis.


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