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Currently filtering by tag: Membranous glomerulopathy

Resolving Membranous Nephropathy

A 40-year-old white male presents with 3 grams/24 hr of proteinuria and swelling around his ankles. He reports that he has had foamy urine over the last 4 months, but was unable to go to a doctor till now because of lack of insurance. Image 1 and image 2 shows irregularly thickened glomerular basement membranes with lamellation. Image 3 shows numerous "holes" on silver stain. Images 4, 5, and 6 show weak staining for IgG, kappa, and lambda, respectively. Membranous nephropathy in a resolving phase can be a tricky diagnosis since the immunofluorescence staining may be extremely weak or negative....

Membranous Lupus Nephritis

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...

Membranous Nephropathy After Transplantation

The biopsy shows a recurrent membranous nephropathy within a transplant. Figure 1 shows "spikes" and "holes." Figure 2 shows mild interstitial fibrosis. Figures 3, 4, 5, and 6 shows IgG, kappa, lambda, and PLA2r, respectively. Figure 7 shows subepithelial and intramembranous deposits. Membranous nephropathy can arise in the graft from recurrence of the original disease, a de novo disease, and rarely as a donor-derived disease. Recurrence of the original disease can be seen as early as one week post transplant. Most cases of recurrent membranous nephropathy occur within the first few months following transplantation, whereas de novo membranous nephropathy usually...

Disease Week: Membranous Glomerulopathy

Membranous glomerulopathy: Looking forward Many excellent reviews are available that detail the current state of knowledge in membranous glomerulopathy so I will not attempt to round out this #DiseaseWeek by writing another. Instead, I would like to paint, with broad brush strokes, what I believe to be the near future of diagnostics in membranous glomerulopathy and discuss the techniques of discovery being applied today that are likely to similarly impact other types of immune complex-mediated glomerulonephritis. We live in exciting times for discovery in medicine as the tools available today are so powerful that the molecular pathogenic mechanisms of disease...

Twitter Poll (February 6, 2019)

Answer: B Minimal change disease is the most common glomerular disease associated with thymoma. Classically, the solid tumors most commonly associated with MN are lung, bronchus, and gastric cancers, followed by renal cell, prostate and thymoma. Other cancers reported with MN are colorectal, pancreatic, esophageal and hepatic carcinomas. References: Ronco PM. Paraneoplastic glomerulopathies: New insights into an old entity. Kidney Int 56: 355–377, 1999 Bacchetta J, Juillard L, et al. Paraneoplastic glomerular diseases and malignancies. Crit Rev Oncol Hematol 70: 39–58, 2009 Lefaucheur C, Stengel B, et al. Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association....

Art of Medicine: Membranous Glomerulopathy

The painting above depicts membranous glomerulopathy.   A single glomerular capillary loop with confluent subepithelial and intramembranous electron dense deposits along the glomerular basement membrane is shown.  Podocytes are showing foot process effacement and microvillous transformation, which results in loss of the filtration barrier leading to nephrotic syndrome.  An electron micrograph from a patient with membranous glomerulopathy is shown below. Membranous glomerulopathy is the second most common cause of nephrotic syndrome in adults.  A majority of cases are considered primary with autoantibodies directed against the podocyte antigens phospholipase A2 receptor (PLA2R, ~70% of cases) or thrombospondin type 1 domain containing 7A...

KDIGO Connections: Membranous Glomerulopathy

Welcome to the first post in our new series KDIGO Connections, a series in which we are asking our nephrologist colleagues to educate us in real-world experiences treating kidney disease. In this series, Dr. David Bourne will be kicking it off with KDIGO guidelines for a kidney disease in visual abstract form. Our hope is that these posts will foster discussion regarding these diseases and how different providers approach them. Please share any points, pearls, questions, caveats, thoughts, or experience you have on the presented disease letting us all learn from your experience!  

Membranous Glomerulopathy in Obesity-Related Glomerulopathy

The patient is a 57-year-old female, with a history of morbid obesity and persistent mild proteinuria (approximately 1 gm), who now presents with nephrotic syndrome and a UPCR of 10.5 g/g. Renal function is normal with a serum creatinine of 0.5 mg/dl. The biopsy shows marked glomerulomegaly with focal areas of perihilar segmental glomerulosclerosis (Fig 1 and 2). Additionally, the capillary loops appear mildly thickened, with frequent subepithelial fuchsinophilic deposits on trichrome stain and diffuse and global holes and spikes seen on silver stain (Fig 3). Immunofluorescence shows global capillary loop granular staining for IgG, C3, kappa, and lambda (Fig...