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Twitter Poll (March 18, 2020)

ANSWER: B Membranous glomerulonephritis (MGN) is the most commonly described glomerular disease in IgG4-related disease. MGN was present in about 7% of cases of IgG4-related tubulointerstitial nephritis from two biopsy series studies.   Other specific glomerular diseases have been reported in patients with IgG4-related disease, including IgA nephropathy/Henoch Schönlein purpura nephritis, membranoproliferative glomerulonephritis (MPGN), and mesangioproliferative immune complex glomerulonephritis.   References: Alexander MP, et al. Membranous glomerulonephritis is a manifestation of IgG4-related disease. Kidney Int 2013; 83:455-462. Saeki T, et al. Membranous nephropathy associated with IgG4-related systemic disease and without autoimmune pancreatitis. Clin Nephrol 2009; 71:173-178. Morimoto J, et al....

Art of Medicine: Membranous Lupus Nephritis

Membranous Lupus Nephritis
The above painting depicts electron microscopy of two glomerular capillary loops and a mesangial region from a case of membranous lupus nephritis, showing intramembranous and mesangial electron-dense deposits.  An electron photomicrograph from a patient with membranous lupus nephritis, showing the same features, is also shown below. Pure membranous lupus nephritis (classified under the International Society of Nephrology / Renal Pathology Society system as class V), without an associated focal or diffuse (proliferative) lupus nephritis, occurs in approximately 15 percent of all patients with renal involvement by systemic lupus erythematosus (SLE).   This percentage is higher in African Americans with SLE.   While...

Membranous Lupus Nephritis

Membranous Lupus Nephritis, arkana laboratories, renal pathology, kidney biopsy
The patient is a 19-year-old female who presents with hematuria, nephrotic range proteinuria, and a creatinine of 1.2 mg/dL. She has a recent diagnosis of systemic lupus erythematosus. Figure 1 shows a normal glomerulus without "spikes" and "holes" of the glomerular basement membranes. Figure 2 shows no significant interstitial fibrosis. Figures 3, 4, 5, & 6 shows IgG, kappa, lambda, and C1q respectively. Image 7 and 8 shows subepithelial deposits. This is a case of membranous lupus nephritis (ISN/RPS Class V). By definition, no proliferative changes (crescents, fibrinoid necrosis, endocapillary hypercellularity) are seen within the glomeruli in a pure class...