This is the IgG immunofluorescence from the biopsy of a 75-year-old female with AKI requiring dialysis. What is your diagnosis?
The picture shows tubular brush border and granular tubular basement membrane staining for IgG. There is also segmental granular glomerular basement membrane staining. This combination of findings is consistent with anti-brush border antibody disease (ABBA), which can be further confirmed by staining with anti-LRP2 (a.k.a. megalin). Normally, LRP2 highlights tubular brush borders only; in ABBA, it is also present in the tubular basement membrane deposits (picture 2).
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