This is the C4d immunofluorescence from a 5 year post-transplant biopsy of an AA female who had ESRD due to lupus nephritis. What is your diagnosis?
The image shows finely granular C4d staining along the glomerular capillary walls. IgG, kappa and lambda were also positive, in the same distribution. These findings are consistent with membranous nephropathy. Ultrastructural examination showed mesangial deposits, in addition to subepithelial and intramembranous deposits. PLA2R. THSD7A, NELL1 and EXT2 stains were negative. The presence of mesangial deposits favors a secondary MN, likely a recurrence of this patient’s original disease.
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